From the Guidelines
Cushing syndrome causes increased hair growth, known as hirsutism, primarily due to excess cortisol production that disrupts normal hormone balance. This condition leads to a variety of symptoms, including mood disorders, menstrual irregularities, and muscle weakness, as well as signs such as weight gain, abdominal striae, and fragile skin 1. The elevated cortisol levels in Cushing syndrome stimulate the production of androgens (male hormones) from the adrenal glands, which in turn stimulate hair follicles to produce thicker, darker hair in areas where women typically have fine, light hair, such as the face, chest, abdomen, and back 1.
The hair growth pattern follows a male distribution pattern because these are androgen-sensitive areas. Additionally, cortisol excess can directly affect hair follicle sensitivity to androgens, making them more responsive even to normal hormone levels. This hormonal imbalance doesn't typically cause scalp hair growth but may actually lead to thinning of scalp hair while promoting body and facial hair growth. According to the most recent guidelines, treatment focuses on addressing the underlying cause of Cushing syndrome, which may include surgical removal of tumors, medication to reduce cortisol production, or management of exogenous steroid use 1.
Key considerations for the management of Cushing syndrome include:
- Accurate diagnosis and careful treatment selection
- Long-term management to optimize patient outcomes
- Use of laboratory tests and imaging to guide treatment decisions
- Management of disease- and treatment-related complications. It is essential to prioritize the management of Cushing syndrome to minimize its impact on morbidity, mortality, and quality of life.
From the Research
Cushing Syndrome and Hair Growth
- Cushing syndrome is a rare endocrine disorder characterized by chronic exposure to excess corticosteroids 2.
- The syndrome can present with various dermatological manifestations, including fragile skin, easy bruising, and reddish purple striae 3.
- However, the relationship between Cushing syndrome and hair growth is more complex, with some studies suggesting that the syndrome can lead to hirsutism, which is characterized by excessive hair growth in women 4, 5.
- Hirsutism is often attributed to androgen excess, which can occur in patients with Cushing syndrome due to the increased production of androgens by the adrenal glands 3.
- In contrast, some patients with Cushing syndrome may experience hair loss, which can be attributed to androgenetic alopecia 3.
- The use of certain medications, such as metyrapone, to treat Cushing syndrome can also lead to hirsutism as a side effect 4, 6.
- Overall, the effect of Cushing syndrome on hair growth is variable and can depend on several factors, including the underlying cause of the syndrome, the presence of androgen excess, and the use of certain medications.
Key Findings
- A study published in 2017 reported a case of a woman with Cushing's disease who presented with hair loss, which was attributed to androgenetic alopecia 3.
- Another study published in 2018 found that metyrapone treatment in patients with Cushing's syndrome led to a decrease in cortisol secretion, but also caused hirsutism in some patients 4.
- A review of the literature published in 2015 noted that hirsutism is a common side effect of metyrapone treatment in patients with Cushing's syndrome 5.
- A retrospective multicenter study published in 2015 found that metyrapone was effective in controlling hypercortisolemia in patients with Cushing's syndrome, but also caused adverse events, including hirsutism, in some patients 6.