Cushing's Syndrome

Cushing's syndrome is a disorder of the hormonal system. It has various manifestations and it can cause significant health problems. It is associated with the hormone known as cortisol. Cortisol belongs among corticosteroids; it is produced in the adrenal cortex and has many functions. These include increase of blood sugar (higher glycemia) and blood pressure, influence on bone metabolism and immune reactions. Corticosteroids are useful in stressful situations where they help to cope with the stress. Their long-term excessive effect may be, however, quite negative.


The production of cortisol by adrenal glands is controlled by brain centers, more precisely by the pituitary gland and the hypothalamus. The hypothalamus produces a substance known as CRH, which acts on the pituitary gland and the pituitary gland and the pituitary produces ACTH acting on the adrenal glands that produce higher amount of cortisol. As usual, there is present a regulatory measure – the cortisol retroactively reduces the production of ACTH in the pituitary gland.


Cushing's syndrome is caused by long-term elevated level of cortisol and other corticosteroids in the body. The situation may be caused by increase production of cortisol, which is caused by local tumor of the adrenal gland (usually benign). Other possibility is increased production of cortisol due to excessive production of ACTH by a pituitary tumor (also usually begin). High amount of ACTH causes excessive stimulation of adrenal glands and production of corticosteroids.


Third, but clearly the most common case of Cushing's syndrome is chronic usage of medications that contain corticosteroids.  The drugs are potent in dampening immune reactions and they are used in allergic reactions, in COPD and in autoimmune diseases.


Cushing's syndrome has many symptoms caused by the corticosteroids. The patient suffers from weight gain and obesity, the maximal amount of fat is located in abdomen and in the facial area (moon face). In contrast, the legs are very thin. The skin of the patient tends to be dry and its strength is reduced with frequent occurrence of the stretch marks. Wound healing is significantly impaired. The patient is tired and suffers from frequent mood swings. Corticosteroids cause hypertension, hyperglycemia and there is higher risk of development of type 2 diabetes. High levels of cortisol reduce bone density and facilitate the emergence of osteoporosis. Women experience disturbance of menstrual cycle and men disruption of sex drive. The combination of usage of corticosteroids and non-steroidal anti-inflammatory drugs significantly increase the risk of peptic ulcer.

Cushing's syndrome


Scheme - Visible symptoms of Cushing's syndrome


The prevention is possible in corticosteroid therapy. Let's just say that corticosteroid usage should be cautiously indicated and patients should take only doses prescribed by the doctor. When possible, we prefer local forms of corticosteroids. The cases of Cushing's syndrome caused by tumors of adrenal glands or pituitary gland can no be effectively prevented.


The therapy depends on the cause. Tumors of the adrenal gland may be treated surgically; tumors of the pituitary gland require neurosurgical approach or targeted destruction by Leksell gamma knife. When the patient uses corticosteroids, it is advisable to lower the dosage, when possible. Unfortunately, there are many serious diseases that require high doses of corticosteroids.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources