Hopkins 24/7

Back to ABC News

This Thursday at 10/9c

This content requires javascript and flash player version 8.

Johns Hopkins Symptoms and Remedies

Johns Hopkins Medicine

Close Article Browser

Cushing's Syndrome

What is it?

Cushing's syndrome—a relatively uncommon disorder named for the twentieth-century American surgeon who identified it—is caused by elevated blood levels of cortisol (an essential corticosteroid hormone). Cortisol is produced by the cortex of the adrenal glands, grape-size organs located above each kidney that form part of the body's endocrine system. Cortisol secretion is stimulated by the release of adrenocorticotropic hormone, or ACTH, from the pituitary gland. Cushing's syndrome is due to overproduction of cortisol by the adrenals or administration of excessive amounts of cortisone in the treatment of a number of diseases. The disorder is known as Cushing's disease when symptoms are due to increased production of ACTH by a tumor in the pituitary gland. Common complications are hypertension, diabetes mellitus, osteoporosis, and muscle weakness. Both Cushing's syndrome and Cushing's disease respond well to treatment.

What Causes It?

  • Large or long-term doses of oral corticosteroid medications—prescribed to treat disorders such as rheumatoid arthritis, inflammatory bowel disease, or asthma—are now the most common cause of Cushing's syndrome.
  • An adrenal tumor or overgrowth (hyperplasia) of adrenal cortex cells may cause Cushing's syndrome.
  • A pituitary tumor that secretes excess ACTH overstimulates cortisol production by the adrenal glands and causes Cushing's disease.
  • Occasionally, tumors elsewhere in the body, such as in the lungs, may produce excess ACTH (ectopicACTH-producing tumor).

Prevention

  • If you are taking corticosteroids on a long-term basis, ask your doctor about taking the lowest possible doses of these medications.

Diagnosis

  • Blood and urine tests to measure levels of adrenal hormones.
  • CT (computed tomography) scans or MRI (magnetic resonance imaging) of the abdomen or skull (to image the pituitary gland).

How to Treat It

  • If Cushing's syndrome is caused by long-term treatment with corticosteroid medications, your doctor may gradually reduce the dosage and switch you to another form of treatment, if possible. Never stop taking corticosteroids on your own, because serious side effects may occur; slow withdrawal should be planned and supervised by a doctor.
  • A pituitary or adrenal tumor can be surgically removed.
  • Radiation therapy, either alone or in conjunction with surgery, may be used to treat tumors.
  • Medications that inhibit the secretion of cortisol, such as ketoconazole, aminoglutethimide,metyrapone, or mitotane, may be prescribed when surgery is impossible or unsuccessful, or when the tumor is malignant.
  • Hormone replacement therapy (temporary or life-long) may be necessary to supplement or replace adrenal and thyroid hormone following surgery or radiation treatment to the pituitary.

When to Call a Doctor

  • Call a doctor if you develop excess fat on your face and torso, accompanied by any of the other symptoms of Cushing's syndrome.