Cushing Syndrome: Symptoms, Causes, Treatment

What are the symptoms of Cushing syndrome?

Cushing syndrome, also known as hypercortisolism, is a condition caused by prolonged exposure to high levels of cortisol, a hormone produced by the adrenal glands. The symptoms of Cushing syndrome can vary but often include:

1. Weight gain: Particularly around the midsection, upper back, and face (resulting in a rounded “moon face”).
2. Fat accumulation: A characteristic “buffalo hump,” which is a fatty deposit between the shoulders.
3. Skin changes: Thin, fragile skin that bruises easily; purple or pink stretch marks (striae) on the abdomen, thighs, breasts, and arms; slow healing of cuts, insect bites, and infections.
4. Muscle weakness: Especially in the upper arms and thighs.
5. Bone loss: Leading to osteoporosis and an increased risk of fractures.
6. High blood pressure: Often resistant to treatment.
7. High blood sugar: Which may lead to diabetes.
8. Mood changes: Including depression, anxiety, irritability, and, in some cases, psychosis.
9. Fatigue: Feeling very tired or weak.
10. Increased thirst and urination: Due to high blood sugar levels.
11. Reproductive issues: Irregular or absent menstrual periods in women; decreased libido and erectile dysfunction in men.
12. Hirsutism: Excessive hair growth on the face and body in women.
13. Cognitive difficulties: Problems with memory and concentration.
14. Headaches: Particularly in cases caused by a pituitary tumor (Cushing’s disease).

If you suspect you have Cushing syndrome, it’s important to seek medical attention for proper diagnosis and treatment. Diagnosis typically involves a series of tests to measure cortisol levels and identify the underlying cause. Treatment may include medications, radiation therapy, or surgery to remove tumors causing the excess cortisol production.

What are the causes of Cushing syndrome?

Cushing syndrome is a rare endocrine disorder caused by an excess of the hormone cortisol in the body. The main causes of Cushing syndrome are:

1. Pituitary adenoma: A non-cancerous tumor in the pituitary gland, called an adrenocorticotropic hormone (ACTH)-secreting adenoma, produces excessive amounts of ACTH, which stimulates the adrenal glands to produce cortisol.
2. Adrenal tumor: A benign or malignant tumor in one or both adrenal glands can produce excessive cortisol, leading to Cushing syndrome.
3. Medications: Taking excessive amounts of corticosteroid medications, such as prednisone, can lead to Cushing syndrome. This is known as exogenous Cushing syndrome.
4. Ectopic ACTH syndrome: In rare cases, a tumor outside the pituitary gland or adrenal glands can produce ACTH, leading to Cushing syndrome.
5. Iatrogenic Cushing syndrome: This occurs when a person is treated with long-term high-dose corticosteroids for a condition such as asthma, rheumatoid arthritis, or lupus, and develops Cushing syndrome as a result.
6. Familial Cushing’s syndrome: A rare genetic disorder caused by a mutation in the gene that codes for the enzyme 11β-hydroxylase, which is involved in cortisol metabolism.

Other less common causes of Cushing syndrome include:

• McCune-Albright syndrome: A genetic disorder characterized by fibrous dysplasia and hyperpigmentation.
• Carney complex: A rare genetic disorder that can cause multiple tumors, including ACTH-secreting tumors.
• Familial isolated pituitary adenomas: A rare genetic disorder that can cause multiple pituitary tumors.

In some cases, the cause of Cushing syndrome may not be identified (idiopathic).

Does Cushing syndrome affect life expectancy?

Cushing syndrome can significantly impact life expectancy, and its effects depend on the underlying cause, severity, and duration of the condition. In general, Cushing syndrome can reduce life expectancy due to the following factors:

1. Cardiovascular disease: High cortisol levels can increase the risk of cardiovascular complications, such as hypertension, heart failure, and cardiac arrhythmias.
2. Diabetes: Cushing syndrome can lead to insulin resistance and type 2 diabetes, which can increase the risk of cardiovascular disease and other complications.
3. Infections: The immune system is suppressed in Cushing syndrome, making patients more susceptible to infections, which can be severe and life-threatening.
4. Osteoporosis: Cortisol excess can lead to bone loss and osteoporosis, increasing the risk of fractures and bone-related complications.
5. Hypertension: Cushing syndrome often causes hypertension, which can lead to cardiovascular complications and kidney damage.
6. Sleep apnea: Cushing syndrome can cause sleep apnea, which can increase the risk of cardiovascular disease and mortality.
7. Mental health: The psychological impact of Cushing syndrome, including anxiety, depression, and mood swings, can significantly affect quality of life.

According to studies:

• A study published in the Journal of Clinical Endocrinology and Metabolism found that patients with untreated Cushing syndrome had a significantly lower life expectancy compared to the general population.
• Another study published in the Journal of Clinical Oncology reported that patients with Cushing syndrome had a higher mortality rate than the general population due to cardiovascular disease and infections.

However, with proper treatment and management, many patients with Cushing syndrome can lead relatively normal lives. Treatment typically involves surgery to remove the tumor or medication to regulate cortisol levels.

In general, life expectancy in Cushing syndrome varies depending on the underlying cause and severity of the condition. On average:

• Untreated Cushing syndrome: 5-10 years
• Treated Cushing syndrome: 15-25 years
• Benign adrenal tumors: 15-30 years
• Pituitary adenomas: 20-40 years

Keep in mind that these are general estimates, and individual outcomes can vary significantly depending on various factors.