Cushing’s Syndrome

Common symptoms of Cushing’s syndrome include:

• Weight gain, including upper body obesity, a round “moon face,” increased fat at the base of the neck, and a fatty hump between the shoulders
• Thin arms and legs
• Severe fatigue
• High blood pressure
• Headache or back pain
• Elevated blood sugar
• Easy bruising
• Purple stretch marks on the skin

Cushing’s syndrome can also cause neurologic symptoms such as muscle weakness and problems with memory and concentration.

Women with Cushing’s syndrome may experience an increase in facial and body hair, acne, and irregular or loss of menstrual periods. Men with Cushing’s syndrome may develop a decrease in fertility, a lower sex drive, and erectile dysfunction.

Cushing’s syndrome can cause serious health issues, including heart attack, stroke, blood clots, impaired immune function that can lead to infections, bone loss, mood disorders, insulin resistance, and type 2 diabetes.

Cushing’s syndrome can be difficult to diagnose because many of its symptoms, such as fatigue and weight gain, can also have other causes. It is sometimes misdiagnosed as polycystic ovary syndrome or metabolic syndrome.

Doctors will typically base a Cushing’s syndrome diagnosis on a physical exam, medical history including any use of glucocorticoids, and lab tests if necessary. Lab tests may include: 

• 24-hour urinary free-cortisol test – Testing a 24-hour urine sample for cortisol, ACTH, and other hormone levels
• Late-night salivary cortisol test – Testing a saliva sample for a normal late-evening drop in cortisol levels (or no drop in the case of Cushing’s syndrome)
• Low-dose dexamethasone suppression test (LDDST) – Blood testing to measure cortisol levels after taking a low-dose glucocorticoid called dexamethasone
• Dexamethasone-CRH test – Blood testing to determine whether excess cortisol is being caused by Cushing’s syndrome or something else

After being diagnosed with Cushing’s syndrome, additional testing can help determine the specific cause—typically categorized as pituitary, ectopic, or adrenal. A blood test that shows a low level of ACTH typically indicates an adrenal tumor, while a normal or high level of ACTH typically indicates a pituitary or ectopic tumor.

Most cases of Cushing’s syndrome can be cured through treatment. The treatment and prognosis of Cushing’s syndrome depends on the cause of excess cortisol in the body. If this is due to long-term use of glucocorticoids to treat another disorder, doctors may recommend reducing the dosage until symptoms of Cushing’s syndrome are controlled.

In the case of tumors or ectopic ACTH syndrome, the most common treatment is surgery to remove the tumors. In these cases, treatment will also focus on minimizing the risk of hormone deficiency or need for medication. Chemotherapy, radiation therapy, and immunotherapy are also options for treating ectopic ACTH syndrome.

For individuals who cannot undergo surgery or still have Cushing’s syndrome after surgery, the U.S. Food and Drug Administration has approved oral tablets and injections that help reduce cortisol levels and improve symptoms.

Research efforts are focused on learning more about Cushing’s syndrome and its causes in order to develop more effective ways to diagnose, treat, and cure the disorder. People with Cushing’s syndrome can participate in clinical trials that test new methods of diagnosis and treatment.