Definition

Cushing syndrome is an endocrine system disorder that has several possible causes. This article discusses Cushing syndrome caused by too much production of cortisol due to an adrenal gland tumor.

Alternative Names

Causes, incidence, and risk factors

Cushing syndrome is caused by constant, high levels of cortisol, a stress hormone. The growth of a tumor on one of the two adrenal glands causes about 15% of all cases of Cushing syndrome. Adrenal tumors release cortisol.

Adrenal tumors may be benign (non-cancerous) or malignant (cancerous). Non-cancerous tumors that may cause Cushing syndrome include adrenal adenomas or micronodular hyperplasia. Adrenal carcinomas are cancerous tumors that may cause Cushing syndrome.

Adrenal tumors are rare. They may develop in anyone at any age, but are much more common in adults. They are found in women more often than men.

For other causes and information about Cushing syndrome see:

Cushing syndrome

Ectopic Cushing syndrome

Exogenous Cushing syndrome

See also:

Cushing's disease

Symptoms

• Moon face (round, red, and full)
• Weight gain
  • Buffalo hump (a collection of fat between the shoulders)
  • The weight gain has a particular pattern -- a protruding abdomen and thin extremities
• Skin changes
  • Thinning of the skin
  • Easy bruising
  • Acne or other skin infections
  • Purple streaks on the skin of the abdomen, thighs, and breasts
• High blood pressure
• Weakness (often noticed when trying to stand up or to raise hand above head)
• Backache
• Headache
• Thirst
• Increased urination
• Mental changes, including an exaggerated feeling of happiness (euphoria), not linked to a life event
• Stopping of menstruation in women
• Breast development and impotence in men

Patients with a cancerous adrenal tumor may also have symptoms of higher-than-normal androgen levels, including excessive hair in unusual parts of the body (in women), acne, and scalp hair loss.

Signs and tests

Tests to confirm Cushing syndrome:

• 24-hour urine sample to measure the following:
  • Urine cortisol
  • Urine creatinine
• Dexamethasone suppression test
• Serum cortisol levels
• Saliva cortisol levels

Tests to determine cause:

• ACTH
• High-dose dexamethasone suppression test
• Abdominal CT (may show adrenal tumor)

Other findings may include:

• High fasting glucose
• Low serum potassium
• Low bone density, seen by dual x-ray absorptiometry (DEXA)
• High cholesterol

Treatment

Cushing syndrome due to an adrenal tumor is treated by surgically removing the tumor and often the entire adrenal gland.

Glucocorticoid replacement treatment is usually needed until the other adrenal gland recovers from surgery. You may need this treatment for 9 to 12 months.

If surgery is not possible (such as in cases of adrenal cancer), medicines can be used to suppress the release of cortisol. These include:

• Mitotane
• Ketoconazole
• Aminoglutethimide
• Metyrapone

Radiation therapy usually does not work for cancerous adrenal tumors and is not appropriate for non-cancerous ones.

Support Groups

Expectations (prognosis)

Patients with an adrenal tumor who have surgery have an excellent outlook. Surgery success rates are very high with this type of tumor.

For adrenal cancer, surgery is sometimes not possible. When surgery is performed, it does not always cure the cancer. Survival time ranges from 14 to 36 months after being diagnosed with a cancerous adrenal tumor.

Complications

Cancerous adrenal tumors can result in the spread of cancer to the liver or lungs.

Calling your health care provider

Call your health care provider if you develop any symptoms of Cushing syndrome.

Prevention

Appropriate treatment of adrenal tumors may reduce the risk of complications in some patients with tumor-related Cushing syndrome.

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