What Is Cushing’s Syndrome? What Are the Symptoms?

Cushing’s syndrome is a hormonal disorder that occurs as a result of having higher-than-normal levels of the cortisol hormone in the body for a prolonged period. Cortisol plays a role in many important processes, including regulating the stress response, controlling blood sugar and blood pressure, and supporting the functioning of the immune system and metabolism. However, when cortisol levels remain elevated for a long time, they can affect different organs and systems in the body and lead to significant health problems.

Cushing’s syndrome may sometimes present only with common everyday complaints such as weight gain or fatigue. Therefore, it is important to recognize the condition and distinguish it from other disorders. In particular, evaluation may be necessary when symptoms such as significant weight gain within a short period, rounding of the face, fat accumulation in the abdominal area, purple-red stretch marks on the skin, easy bruising, and muscle weakness occur together.

Prof. Dr. Ömür Günaldı emphasizes the importance of evaluating the patient’s complaints as a whole when assessing clinical conditions that may be associated with hormonal imbalances such as Cushing’s syndrome. Since Cushing’s syndrome may be caused by disorders involving the pituitary gland, adrenal glands, or hormone production originating from other parts of the body, the diagnostic process should be planned individually for each patient.

What Causes Cushing’s Syndrome?

The main cause of Cushing’s syndrome is prolonged exposure of the body to high levels of cortisol. The most common cause is the long-term or high-dose use of corticosteroid medications used in the treatment of certain diseases. In addition, excessive production of cortisol by the body itself can also cause Cushing’s syndrome.

Causes that may lead the body to produce excessive cortisol include:

• An ACTH-producing tumor in the pituitary gland
• A cortisol-producing tumor in the adrenal gland
• Tumors in other parts of the body that produce ACTH
• Certain rare hormonal disorders
• Long-term or high-dose corticosteroid use

Cushing’s syndrome caused by excessive ACTH secretion from the pituitary gland is specifically called Cushing’s disease. Cushing’s disease and Cushing’s syndrome are not the same concepts. Cushing’s disease refers to a specific cause of Cushing’s syndrome.

What Are the Symptoms of Cushing’s Syndrome?

The symptoms of Cushing’s syndrome may vary from person to person. The degree of cortisol elevation and how long it has persisted can affect the severity of symptoms. In some people, symptoms progress slowly, while in others, more noticeable physical changes may occur.

Rapid and Significant Weight Gain

One of the most noticeable symptoms of Cushing’s syndrome is weight gain, particularly in the central part of the body. While the arms and legs may remain relatively thin, fat accumulation may occur in the abdomen, chest, and upper back.

Therefore, it is important to consider not only weight gain itself but also changes in the distribution of body fat.

Rounding of the Face

As a result of excess cortisol, fatty tissue in the face may increase, causing the face to develop a rounder appearance. This appearance is sometimes commonly described as a “moon face.”

Rounding of the face alone does not mean that a person has Cushing’s syndrome. However, when it occurs together with other characteristic symptoms, it may need to be evaluated by a doctor.

Fat Accumulation in the Abdomen and Upper Body

In Cushing’s syndrome, fat accumulation may become particularly noticeable in the trunk, abdomen, neck, and upper back. Increased fatty tissue between the shoulders may result in a noticeable fat deposit.

Purple or Red Stretch Marks on the Skin

Wide pink, red, or purple stretch marks may develop, particularly on the abdomen, hips, thighs, breasts, and underarm areas.

One of the notable characteristics of stretch marks associated with Cushing’s syndrome is that they tend to be wide and prominent. These skin changes may be an important clinical clue to the condition.

Thinning of the Skin and Easy Bruising

High cortisol levels can affect the structure of the skin. The skin may become thinner and more sensitive. As a result, bruising may occur easily even after minor trauma. Wounds may also take longer than usual to heal.

Muscle Weakness

Muscle loss and muscle weakness may occur in Cushing’s syndrome. Difficulty may be experienced particularly when climbing stairs, getting up from a chair, or performing everyday physical activities.

Because muscle weakness can significantly affect a person’s quality of life, it is one of the symptoms that should be taken into consideration.

High Blood Pressure

Excess cortisol may have adverse effects on blood pressure. Therefore, newly developed hypertension in a person who previously had no blood pressure problems, or hypertension that becomes difficult to control, should be evaluated together with other symptoms.

Elevated Blood Sugar

Cortisol is one of the important hormones that affects blood sugar metabolism. Prolonged excess cortisol may cause blood sugar levels to rise and may increase the risk of developing diabetes in some individuals.

Menstrual Irregularities and Excessive Hair Growth

In women, Cushing’s syndrome may cause menstrual irregularities or the complete cessation of menstrual periods. In addition, excessive hair growth on the face and body may occur.

Since these symptoms may also occur in different hormonal disorders, it is not appropriate to diagnose Cushing’s syndrome based solely on these findings.

Psychological and Cognitive Changes

Elevated cortisol levels may affect not only physical appearance but also psychological well-being. Depression, anxiety, restlessness, mood changes, difficulty concentrating, and difficulties in thinking processes may occur.

How Is Cushing’s Syndrome Diagnosed?

Cushing’s syndrome cannot be diagnosed solely through a physical examination. This is because symptoms such as weight gain, high blood pressure, elevated blood sugar, depression, or menstrual irregularities are quite common in the general population and may occur for many different reasons.

Therefore, the doctor first evaluates the medications the patient is taking, particularly medications containing corticosteroids. If considered necessary, biochemical tests that investigate elevated cortisol levels are then performed:

• 24-hour urinary free cortisol measurement
• Late-night salivary cortisol test
• 1 mg dexamethasone suppression test
• Additional hormonal evaluations when necessary

The Endocrine Society recommends using one of the appropriate initial tests in patients with suspected Cushing’s syndrome and confirming abnormal results through further evaluation.

After the diagnosis has been confirmed, ACTH measurement and, in appropriate patients, imaging methods targeting the pituitary gland or adrenal glands may be used to determine the source of the condition.

What Is the Difference Between Cushing’s Syndrome and Cushing’s Disease?

Although these two terms are often used interchangeably, they do not mean the same thing.

Cushing’s syndrome refers to the general clinical condition that develops when the body is exposed to excessive cortisol for a prolonged period.

Cushing’s disease, on the other hand, is a type of Cushing’s syndrome caused by an ACTH-secreting tumor in the pituitary gland that leads to excessive cortisol production.

Therefore, every case of Cushing’s disease is Cushing’s syndrome, but not every case of Cushing’s syndrome is caused by Cushing’s disease.

Can Cushing’s Syndrome Be Treated?

The treatment of Cushing’s syndrome is determined according to the underlying cause of the condition. The aim is to eliminate the effects of excessive cortisol in the body and control the health problems caused by it.

The Endocrine Society guidelines state that, in appropriate patients with endogenous Cushing’s syndrome, surgical removal of the underlying tumor is the primary treatment approach. In cases where this is not possible or the disease persists, medication treatments, radiotherapy, or other treatment options may be considered.

• Surgical treatment for pituitary tumors
• Appropriate surgical treatment for adrenal gland tumors
• Treatment of tumors elsewhere in the body that secrete ACTH
• Medical treatment in cases where surgery is not suitable or the disease persists
• Radiosurgery or radiotherapy in some pituitary-related conditions
• Treatment of blood pressure problems, diabetes, bone loss, and other complications associated with Cushing’s syndrome

Prof. Dr. Ömür Günaldı emphasizes the importance of a multidisciplinary approach in Cushing’s syndrome, in which not only the elevated hormone levels but also the effects of the disease on the patient’s overall health are evaluated.

Is Cushing’s Syndrome Dangerous If Left Untreated?

If Cushing’s syndrome is left untreated, it may affect different organs and systems over time. The risk of high blood pressure, elevated blood sugar, bone loss, muscle weakness, susceptibility to infections, and cardiovascular problems may increase. Psychological symptoms may also become more pronounced in some patients.

Therefore, it is important for individuals who experience progressive symptoms, particularly multiple symptoms occurring together, to undergo evaluation. The Endocrine Society also recommends monitoring and treating associated health conditions in patients with Cushing’s syndrome.

Why Is Early Diagnosis Important in Cushing’s Syndrome?

Cushing’s syndrome may sometimes remain undetected for a long time. One important reason for this is that its symptoms may initially resemble those of other conditions. For example, weight gain, fatigue, or high blood pressure alone may not immediately suggest Cushing’s syndrome.

However, if symptoms increase over time and particularly if characteristic physical changes are added to the clinical picture, a more detailed evaluation may be necessary.

Early diagnosis makes it possible to identify the cause of excessive cortisol production and develop an appropriate treatment plan. Returning cortisol levels to normal with treatment may help control many of the symptoms and complications associated with Cushing’s syndrome.

Which Doctor Should You See for Cushing’s Syndrome?

When Cushing’s syndrome is suspected, an evaluation by an endocrinology and metabolism specialist may initially be appropriate. Depending on the source of the condition, support may also be obtained from specialists in brain and pituitary surgery, general surgery, radiation oncology, or other relevant medical specialties.

Particularly in pituitary-related Cushing’s disease, evaluation by an experienced medical team is of great importance. Establishing the correct diagnosis, determining the source of the condition, and selecting the appropriate treatment method are complementary stages of the process.

In patients evaluated by Prof. Dr. Ömür Günaldı, detailed assessment of clinical findings, planning the necessary hormone tests, and conducting examinations aimed at identifying the source of the condition are also important parts of the treatment process.

Cushing’s syndrome is an important hormonal disorder caused by prolonged excess cortisol and can affect many systems in the body. In particular, the condition may need to be investigated when symptoms such as rapid weight gain in the trunk area, a rounded face, fat accumulation in the upper back, purple-red skin stretch marks, easy bruising, muscle weakness, high blood pressure, and elevated blood sugar occur together.

The diagnostic process is carried out not only by evaluating symptoms but also through appropriate hormone tests and, when necessary, imaging methods. Once the cause of the condition has been identified, an individualized treatment plan is developed. Therefore, specialist evaluation is important if symptoms persist for a long time or become increasingly noticeable.

Prof. Dr. Ömür Günaldı emphasizes the importance of thoroughly evaluating the patient’s symptoms, conducting the diagnostic process accurately, and developing a treatment plan directed at the underlying cause of the condition in the assessment of Cushing’s syndrome and similar neuroendocrine conditions.