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Cushing Syndrome

Chronic Cortisol Excess — Diagnosis and Etiologic Workup

Written by: Saygı Hospital Health Guide Editorial Board
Published:

This content is for general information; please consult your physician for diagnosis and treatment.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Endokrinoloji department. Book Appointment →

What is Cushing Syndrome?

Cushing syndrome is caused by chronic hypercortisolism from exogenous glucocorticoids (most common) or endogenous ACTH-dependent (pituitary Cushing disease, ectopic ACTH) or ACTH-independent adrenal disorders.

Clinical features include central obesity, thin extremities, facial plethora, violaceous striae, hypertension, glucose intolerance, and hypogonadism.

Screening relies on two abnormal first-line tests: 24-h urinary free cortisol, late-night salivary cortisol, or 1-mg overnight dexamethasone suppression.

Subsequent workup includes ACTH, high-dose dexamethasone suppression, pituitary MRI, and inferior petrosal sinus sampling or adrenal imaging.

Symptoms

Central obesity, supraclavicular fat pads, buffalo hump, and moon facies
Thin skin, easy bruising, poor wound healing, purple striae
Proximal muscle weakness and myopathy
Hypertension and glucose intolerance or diabetes
Mood changes: depression, anxiety, insomnia, or psychosis
Menstrual irregularity, hirsutism, acne, and low libido

Risk Factors

Chronic exogenous glucocorticoid therapy (most common cause)
Pituitary corticotroph adenoma (Cushing disease)
Ectopic ACTH-secreting tumors (small cell lung cancer, bronchial carcinoid)
Adrenal adenoma or carcinoma
Genetic causes: MEN1, Carney complex, PPNAD, McCune-Albright
Female sex and age 20–50 years for pituitary Cushing

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Progressive central obesity with thin limbs and purple striae
  • Unexplained hypertension or diabetes with cushingoid features
  • Proximal weakness, osteoporotic fractures, or mood changes with risk factors

Treatment Methods

01
Exogenous: taper glucocorticoids with HPA-axis recovery planning
02
Cushing disease: transsphenoidal surgical resection of pituitary adenoma first-line
03
Ectopic ACTH: resection of source tumor; medical therapy (ketoconazole, osilodrostat, metyrapone) for control
04
Adrenal causes: unilateral adrenalectomy for adenoma; surgery + mitotane for carcinoma
05
Bilateral adrenalectomy for refractory cases; lifelong glucocorticoid/mineralocorticoid replacement
06
Management of comorbidities: hypertension, diabetes, osteoporosis, VTE prophylaxis, psychiatric support

Which Department to Visit?

You can visit our Endokrinoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.