Published: 18 Jun 2025

ICD9: 255.0      ICD10: E24.9      ICD11: 5A70

Cushing's Syndrome, also known as hypercortisolism, is a hormonal disorder caused by prolonged exposure of the body's tissues to high levels of the hormone cortisol.
Cortisol is a steroid hormone produced by the adrenal glands, and it plays a vital role in regulating various bodily functions, including:

Stress response: Helping the body cope with stress.
Blood sugar regulation: Influencing insulin release and blood sugar levels.
Immune system function: Suppressing inflammation.
Blood pressure: Helping to maintain blood pressure.

Causes:

Cushing's Syndrome can be caused by different factors, which can be broadly categorized as:

1. Exogenous Cushing's Syndrome: This is the most common cause, resulting from taking high doses of corticosteroid medications, such as prednisone, for a long period. These medications are often prescribed to treat inflammatory conditions like arthritis, asthma, or autoimmune diseases.

2. Endogenous Cushing's Syndrome: This occurs when the body produces too much cortisol on its own. The causes of endogenous Cushing's Syndrome include:

Pituitary Adenoma (Cushing's Disease): A benign tumor in the pituitary gland that secretes excessive adrenocorticotropic hormone (ACTH). ACTH stimulates the adrenal glands to produce cortisol.
Ectopic ACTH-Secreting Tumors: Tumors in other parts of the body (e.g., lung, pancreas) that produce ACTH, leading to increased cortisol production by the adrenal glands.
Adrenal Gland Tumors: Tumors in the adrenal glands themselves (either benign or cancerous) that produce excess cortisol.

Symptoms:

The signs and symptoms of Cushing's Syndrome vary from person to person, but some common features include:

Weight gain: Particularly in the midsection and upper back.
Rounded face (moon face): Facial fullness.
Fatigue and muscle weakness: Due to protein breakdown.
High blood pressure: Cortisol can affect blood pressure regulation.
High blood sugar (hyperglycemia): Increased risk of diabetes.
Easy bruising: Thinning of the skin and blood vessel fragility.
Purple or pink stretch marks (striae): Usually on the abdomen, thighs, breasts, and arms.
Acne: Hormonal imbalances can trigger acne breakouts.
Increased thirst and urination: High blood sugar can lead to this.
Osteoporosis: Loss of bone density, increasing the risk of fractures.
Mood changes: Including irritability, anxiety, depression, and difficulty concentrating.
In women: Menstrual irregularities, increased facial and body hair (hirsutism).
In men: Decreased libido, erectile dysfunction.
Slow wound healing: Impaired immune function.

Diagnosis:

Diagnosing Cushing's Syndrome involves a thorough medical history, physical examination, and various tests to assess cortisol levels. These tests may include:

Urine cortisol test: Measures cortisol levels in the urine over a 24-hour period.
Saliva cortisol test: Measures cortisol levels in saliva at night (cortisol levels are normally lower at night).
Dexamethasone suppression test: A medication is given to suppress cortisol production; the test assesses whether cortisol levels are suppressed as expected.
Blood ACTH test: Measures ACTH levels in the blood to help determine the cause of Cushing's Syndrome.
Imaging studies: Such as CT scans or MRI scans of the pituitary gland, adrenal glands, or other areas to identify tumors.

Treatment:

The treatment for Cushing's Syndrome depends on the underlying cause:

Reducing Corticosteroid Use: If the cause is exogenous Cushing's Syndrome, gradually reducing the dosage of corticosteroid medications or switching to alternative medications, under medical supervision, is the primary goal.
Surgery: Surgical removal of pituitary tumors, adrenal tumors, or ectopic ACTH-secreting tumors may be necessary.
Radiation Therapy: Can be used to shrink pituitary tumors if surgery is not feasible or is unsuccessful.
Medications: Medications can be used to control cortisol production in cases where surgery or radiation therapy are not options, or as an adjunct to these treatments. Examples include ketoconazole, metyrapone, and osilodrostat.

Complications:

If left untreated, Cushing's Syndrome can lead to various complications, including:

Diabetes
High blood pressure
Osteoporosis and fractures
Infections
Muscle loss and weakness
Mental health problems (depression, anxiety)
Blood clots
Heart attack and stroke

Important Note: If you suspect you may have Cushing's Syndrome, it is important to consult a doctor for proper diagnosis and treatment. Self-treating or ignoring the symptoms can lead to serious health consequences.