Cushing's syndrome is a hormonal disorder. It is caused by prolonged exposure to the hormone cortisol.

Hormones are chemicals in the body. Cortisol is a common hormone. In normal doses it helps the body manage stress and infection.

Prolonged or excess exposure to cortisol as a result of:

• Long-term use of corticosteroid hormones such as cortisone or prednisone
• Tumor or abnormality of the adrenal gland, which causes the body to produce excess cortisol
• Tumor or abnormality of the pituitary gland, which causes the body to produce excess cortisol (in the case of a pituitary tumor , it is called Cushing's disease)
• Rarely, tumors of the lungs, thyroid, kidney, pancreas, or thymus gland produce hormones that trigger the syndrome

Factors that increase your risk of Cushing's syndrome include:

• Chronic use of corticosteroid medicines
• Age: 20-50 years
• Sex: female (much more common in women)

Although symptoms may vary, common symptoms of Cushing's syndrome are:

• Weight gain of the upper body and trunk
• Face shaped like a moon
• Skin changes:
  • Darkening of the skin
  • Purple stretch marks
  • Easy bruising
• Excess hair growth or acne in women
• Menstrual disorders, especially infrequent or absent periods
• Diminished fertility and libido
• High blood pressure
• Water retention or swelling
• High blood sugar or diabetes
• Tiredness or fatigue
• Personality changes or mood swings
• Muscle weakness
• Osteoporosis or brittle bones
• Skeletal growth retardation in children
• Increased thirst
• Frequent urination
• Psychosis
• Low back pain

The doctor will ask about your symptoms and medical history. A physical exam will be done.

• 24-hour urinary free cortisol level—Urine is collected for 24 hours and tested.
• Late-evening cortisol saliva/blood level—Saliva or blood is collected around 11 pm and tested.
• Dexamethasone suppression test—A synthetic cortisol called dexamethasone is taken by mouth; blood and urine samples may be taken overnight or over several days.

• CRH stimulation test
• ACTH level
• High-dose dexamethasone suppression test

These tests may show whether there is a tumor in the pituitary or adrenal glands or another area of the body. Common imaging tools include:

• MRI scan —a test that uses magnetic waves to make pictures of the inside of the body
• CT scan —a type of x-ray that uses a computer to make pictures of structures inside the body
• Chest x-ray —which may detect tumors in the lungs

Treatment of Cushing's syndrome depends on the cause.

Treatments include:

• Surgical removal of tumor
• Surgical removal of part, all, or both adrenal glands
• Radiation for some persistent tumors
• Gradual withdrawal of cortisone-type drugs under close medical supervision
• Drugs that decrease cortisol production or block the functioning of other adrenal products