Cushing’s Disease and Cushing’s Syndrome

Weight gain is common. So are fatigue, bruising, and changes in blood pressure. But if several of these problems start happening together, there may be more going on. In some cases, the cause is too much cortisol.

Cushing’s disease and Cushing’s syndrome both involve high cortisol levels, but they aren’t exactly the same condition.

Diabetes & Glandular Disease Clinic provides diagnosis and treatment for Cushing’s disease, Cushing’s syndrome, and other hormone disorders in San Antonio.

Cushing’s disease happens when a tumor in the pituitary gland makes too much adrenocorticotropic hormone (ACTH). ACTH tells your adrenal glands to make cortisol. Increased ACTH can cause your body to make more cortisol than it needs.

The pituitary tumors that cause Cushing’s disease are usually small and benign, which means they aren’t cancer.

Your body needs cortisol. It helps you respond to stress and plays a role in controlling blood pressure, blood sugar, and metabolism.

Your cortisol level normally rises and falls throughout the day. When it stays too high for too long, it can affect your muscles, skin, bones, blood pressure, blood sugar, and the way your body stores fat.

Cushing’s disease is one type of Cushing’s syndrome.

Cushing’s syndrome happens when you have too much cortisol in your body for a long time. Your body may do this on its own. Some steroid medicines can also cause Cushing’s syndrome when taken for a long time. These include glucocorticoids such as prednisone.

Excessive cortisol can be caused by:

• A tumor in the adrenal gland
• A tumor in the pituitary gland
• An ACTH-producing tumor elsewhere in the body

The term Cushing’s disease is used specifically when an ACTH-producing pituitary tumor is causing the high cortisol levels.

Symptoms often develop slowly, so you may notice several changes over time.

Symptoms can include:

• Weight gain, especially around the abdomen and upper body
• A rounder or fuller face
• More fat around the neck or above the collarbones
• More fat on the upper back
• Arms and legs that look thinner compared with the upper body
• Easy bruising
• Wide purple or reddish-purple stretch marks
• Muscle weakness
• Fatigue
• High blood pressure
• High blood sugar
• Acne
• Changes in mood, sleep, memory or concentration

Women may have irregular periods or more facial and body hair. Men may notice a lower sex drive, erectile dysfunction, or fertility problems.

Not everyone has the same symptoms. Many of these changes can also happen with other conditions, which is one reason Cushing’s syndrome can be difficult to recognize.

High cortisol levels can change where your body stores fat. More fat may build up around your abdomen, face, neck, and upper back.

At the same time, high cortisol can weaken the muscles in your arms and legs. This means you may gain weight around your abdomen while your arms and legs become thinner.

You may first notice the weakness during everyday activities. Climbing stairs or getting out of a low chair can become harder than it used to be.

High cortisol can make your skin thinner and easier to bruise. You may notice bruises after small bumps that wouldn’t normally leave a mark.

Cushing’s syndrome can also cause wide stretch marks that are red, purple, or violet. They often appear on the:

• Abdomen
• Hips
• Breasts
• Thighs
• Underarms

Some people also develop acne or notice that cuts and other wounds take longer to heal.

Too much cortisol can weaken your bones over time. This may lead to osteopenia or osteoporosis.

Weaker bones are more likely to break. This can be especially concerning when bone loss happens at a younger age than expected.

Excessive cortisol can raise your blood pressure. It can also make it harder for your body to respond to insulin.

This can cause your blood sugar to rise. Some people develop insulin resistance, prediabetes or type 2 diabetes.

Cushing’s syndrome can also affect cholesterol levels and increase the risk of blood clots, heart attack, and stroke. Some people have more infections or notice changes in their mood, memory, or concentration.

Cushing’s syndrome can be difficult to diagnose because symptoms such as weight gain and fatigue are common with many other conditions.

Your doctor will ask about your symptoms and medical history. Be sure to mention any steroid medicines you take, including glucocorticoids such as prednisone.

Tests used to check for high cortisol may include:

• Late-night salivary cortisol
• 24-hour urinary free cortisol
• A dexamethasone suppression test

You may need more than one test to confirm that your cortisol level is too high.

If your cortisol is too high, the next step is figuring out why. An ACTH blood test can help your doctor narrow down the cause.

You may also need additional blood tests or imaging. If your doctor suspects a problem with your pituitary gland, you may have a pituitary MRI. Sometimes more specialized testing is needed to find the source of the high cortisol.

Treatment depends on what’s causing your cortisol levels to stay high.

It may include:

• Surgery
• Medication
• Radiation therapy
• Changes to glucocorticoid treatment

For Cushing’s disease, surgery to remove the pituitary tumor is usually the first choice for treatment.

Other forms of Cushing’s syndrome may require treatment for a tumor in the adrenal gland or another part of the body. Some people need medication to lower their cortisol levels.

If a glucocorticoid medication is causing Cushing’s syndrome, your doctor may slowly lower the dose when it’s safe to do so. Don’t suddenly stop taking a prescribed steroid unless your doctor tells you to. These medications often need to be reduced gradually.

You’ll also need follow-up testing after treatment. This allows your doctor to check your cortisol levels and watch for signs that the condition has returned.

It can be hard to know what’s behind symptoms like weight gain, muscle weakness, easy bruising, or changes in blood pressure and blood sugar. An endocrinologist can look at your symptoms, medical history, and test results to find out if a hormone problem may be involved.

Diabetes & Glandular Disease Clinic provides care for Cushing’s disease, Cushing’s syndrome, and other pituitary and adrenal conditions in San Antonio. Contact DGD Clinic to schedule an appointment if you’re concerned about your symptoms or need ongoing care for a hormone disorder.

1. Does Everyone With Cushing’s Syndrome Gain Weight?

No. Symptoms vary from person to person. When weight gain does occur, fat often builds up around the abdomen, face, neck, and upper back. The arms and legs may look thinner because of muscle loss.

Weight gain alone doesn’t mean you have Cushing’s syndrome.

2. Is a Pituitary Tumor With Cushing’s Disease Cancer?

The pituitary tumors that cause Cushing’s disease are almost always benign, which means they aren’t cancer.

Even a very small tumor can make enough ACTH to cause high cortisol levels and symptoms.

3. Can Prednisone Cause Cushing’s Syndrome?

Yes. Some steroid medicines can cause Cushing’s syndrome when taken for a long time. These include glucocorticoids such as prednisone.

Don’t stop taking a prescribed steroid suddenly. Your doctor can determine whether your dose should be changed and how to reduce it safely.

4. Can Cushing’s Syndrome Cause Diabetes?

Yes. High cortisol levels can make it harder for your body to respond to insulin and can raise your blood sugar. Some people develop prediabetes or type 2 diabetes.