Cushing syndrome is a rare hormonal disorder. It’s also called Cushing's syndrome or hypercortisolism. In people who have it, their bodies make too much cortisol. That’s a hormone that helps control blood sugar levels, regulate your metabolism, assist with memory function and regulate inflammation. It’s named after Harvey Cushing, a neurosurgeon who discovered the link between pituitary tumors and cortisol while operating on brain tumors.
According to the National Institute of Diabetes and Digestive and Kidney Diseases, Cushing syndrome affects 40 to 70 out of every million people each year. It’s usually diagnosed in people between the ages of 30 to 50, but can be found in people outside that range, including children. It’s three times more common in women than in men.
Cushing syndrome develops when you have too much of the hormone cortisol in your body. Cortisol is often referred to as the stress hormone. That’s because your adrenal glands release it to help you cope with stress. Cortisol also helps regulate blood pressure and blood sugar, regulate inflammation, support your memory and convert food into energy.
Cushing syndrome risk factors include long-term use of high doses of corticosteroid medications, such as prednisone. These drugs are similar to cortisol. They are often used to treat asthma, lupus and rheumatoid arthritis. They are also used after organ transplants to help suppress the immune system. Injectable versions of these medications treat joint pain and bursitis. This type of Cushing syndrome is called exogenous Cushing syndrome, meaning it’s caused by factors that come from outside of the body.
Cushing syndrome can also occur if you have:
These types are called endogenous Cushing syndrome because they are caused by factors within the body. The symptoms of exogenous and endogenous Cushing syndrome are the same.
Cushing disease is a form of Cushing syndrome. It’s the type that’s caused by a noncancerous (benign) pituitary tumor.
Cushing syndrome can be hard to spot. Not everyone has symptoms. And some symptoms could be related to other conditions. For example, polycystic ovary syndrome (PCOS) and metabolic syndrome can have similar symptoms to Cushing syndrome.
If you have high cortisol levels for a long period of time, you’ll probably notice some of these signs of Cushing syndrome:
One of the dangerous things about this condition is that it can cause other serious health issues. People with Cushing syndrome can have complications including:
It can be fatal if left untreated because of the many complications it can cause to your body.
Speak with your primary care doctor if you think you have Cushing syndrome. Treating it early is essential. That way, you can reduce your risk of complications and recover more quickly.
Your doctor or a health care professional such as an endocrinologist (a doctor who specializes in hormonal disorders) will perform a physical exam and review your medical history. If you’re taking medication that might be causing Cushing syndrome, you may not need additional testing. That’s because the medication is likely the cause.
If not, these tests can evaluate your cortisol levels for a Cushing syndrome diagnosis:
If you’re diagnosed with Cushing syndrome, your doctor may recommend additional blood tests and imaging studies to find out what’s causing it. Blood tests can compare cortisol levels with ACTH levels.
Treating Cushing syndrome can return your cortisol levels to normal and help alleviate your symptoms.
Treatment depends on what’s causing the condition. Treatment options for a tumor include medication, radiation, chemotherapy and/or surgery.
Your high cortisol levels might be due to steroid medications you’re taking. In that case, your doctor may try to adjust those medications or take you off them entirely. Sometimes, you only need these medications for a short time. And in some cases, other drugs can replace them.
Medications such as ketoconazole, mitotane (Lysodren), levoketoconazole (Recorlev), metyrapone (Metopirone), pasireotide (Signifor) and osilodrostat (Isturisa) are also effective in lowering cortisol levels. Mifepristone (Korlym, Mifeprex) may be used in people who have type 2 diabetes or high blood sugar. It limits the effects cortisol has in the body.
Medications are often options when surgery and radiation don’t work. They may also be used before surgery in people who are very sick with Cushing syndrome. These medications can have serious side effects that affect the brain, nervous system or liver.
There’s no Cushing syndrome diet that can cure the condition. But you can choose foods that help keep your cortisol levels in check. Cushing syndrome can lead to high blood glucose levels, so good choices that keep blood glucose more stable include fish, nuts, berries and non-starchy vegetables. Limit alcohol, refined carbohydrates and sodium.