Cushing’s Syndrome and Disease

Cushing’s syndrome is a condition where your body makes too much cortisol, a hormone produced by your adrenal glands. When the pituitary gland is the root cause of the excess cortisol, it is called Cushing’s disease. Cushing's disease is rare. It most commonly affects women between 20 and 50 years old.

Cushing’s disease is often caused by benign tumors in the pituitary gland. This tumor spurs a reaction that leads the adrenal glands to release too much cortisol. Cortisol is known as the stress hormone, but it also regulates your thyroid glands, sexual organs and growth hormone. So too much cortisol can have a wide range of impacts throughout your body. Often a surgery to remove the tumor will reverse or lessen the symptoms of Cushing’s disease.

Cushing’s syndrome can have a variety of causes. It may be from long-term use of glucocorticoid medications. These are steroids commonly used to treat inflammation, like cortisone or prednisone. It can also result from a tumor in another part of the body, such as the lungs, pancreas, thyroid, thymus or adrenals. Finally, it could be an inherited syndrome.

The most common symptom of Cushing’s is weight gain, especially in the midsection, face or between the shoulders – often called a buffalo hump. With weight gain in these areas, the arms and legs stay thin. Pink or purple stretch marks are also a frequent symptom especially on the stomach, hips and thighs.

Other symptoms include:

• Acne
• Bruising easily
• Dark hair on the face and body (for women)
• Extreme fatigue and muscle weakness
• Headache
• High blood pressure
• High blood sugar

Cushing’s syndrome leads to higher risk of osteoporosis, blood clots and overall mortality.

There are 3 screening tests used to help diagnose Cushing’s syndrome if you are experiencing symptoms. There are many factors that could cause false positive results, so doctors may have to repeat the tests on multiple occasions and identify at least 2 of these tests before making a diagnosis.

Salivary test

You will collect saliva samples between 11 p.m. and midnight by placing a piece of special cotton in your mouth. It is then put in a tube, sent to a lab and screened for your cortisol level.

Dexamethasone suppression test

You will be given a dose of dexamethasone to take between 11 p.m. and midnight. The following morning you will get blood drawn to measure your cortisol level.

24-hour urine collection

You will collect all of your urine over the course of 24 hours. It will then be tested to determine your cortisol level.

If your levels are abnormal on multiple occasions, more confirmatory blood tests will be required, and you may be sent for an MRI of your brain to see if there is a tumor in your pituitary gland.

The main treatment for Cushing’s disease is surgery to remove tumors in the pituitary gland.

Following surgery, some people may need to take cortisol medications until the pituitary gland returns to producing it normally.

If surgery isn’t an option or isn’t successful, patients may get radiation therapy. Certain types of tumors may need to be treated with chemotherapy or other cancer treatments. Finally, medications that inhibit the production of cortisol may be prescribed.

The symptoms of Cushing’s disease may be lessened by lifestyle changes. These include limiting foods with sodium, engaging in gentle exercise and getting massages. These will not cure Cushing’s but may make you more comfortable.

We have a highly skilled team of endocrinologists who specialize in the treatment of disorders of the glands and hormones. They work closely with obstetrics and gynecology specialists in female reproductive care and urology specialists in male reproductive care. In addition, because of the multidisciplinary nature of our care teams, we provide the most comprehensive care for thyroid and pituitary gland conditions. Our endocrinologists work closely with thyroid surgeons and the pituitary neurosurgeon care team.

Surgeons at The University of Kansas Health System utilize minimally invasive techniques. They can use your nasal passageway to remove the tumor – no large incision necessary. Additionally, our surgeons conduct these procedures frequently. Their experience and training are key to achieving the best outcomes for a complex procedure.