From the Guidelines
Cushing's syndrome presents with a constellation of symptoms resulting from prolonged exposure to high cortisol levels, including weight gain, purple stretch marks, thin skin, facial redness, excess hair growth, and mood changes, as noted in the most recent study 1.
Symptoms of Cushing's Syndrome
The symptoms of Cushing's syndrome can be divided into several categories, including:
- Physical symptoms: weight gain, particularly in the face, trunk, and upper back, while the arms and legs remain thin, as well as purple stretch marks on the abdomen, thighs, and breasts, and thin, fragile skin that bruises easily 1.
- Dermatological symptoms: facial redness, excess facial hair in women, and acne 1.
- Muscular symptoms: muscle weakness and fatigue 1.
- Cardiovascular symptoms: high blood pressure and high blood sugar 1.
- Psychological symptoms: mood changes, including depression, anxiety, and irritability 1.
Severity of Symptoms
The severity of symptoms varies depending on how long cortisol levels have been elevated and how high those levels are, as noted in the study 1.
Quality of Life
Cushing's syndrome can significantly impact a patient's quality of life, with long-term consequences including bone loss, osteoporosis, and fractures, as well as increased susceptibility to infections and poor wound healing 1. Therefore, it is essential to accurately diagnose and manage Cushing's syndrome to minimize its impact on morbidity, mortality, and quality of life, as recommended in the most recent guideline update 1.
From the Research
Cushing's Syndrome Symptoms
The symptoms of Cushing's syndrome are varied and can be caused by excessive exposure to exogenous or endogenous glucocorticoid hormones 2, 3. Some common symptoms include:
- Weight gain, particularly in the face, back of the neck, and visceral organs
- Hyperglycemia, hypertension, and excess fat deposition
- Skin changes such as facial plethora, easy bruising, and purple striae
- Neurocognitive changes and mood disorders
- Impaired cardiovascular and metabolic function, infections, and neuropsychiatric disorders
Clinical Presentation
The clinical presentation of Cushing's syndrome can vary, and some signs and symptoms are common in the general population, making diagnosis challenging 4, 5. However, some frequent clinical findings include:
- Truncal obesity, striae, hypertension, glucose intolerance, and infections
- Proximal muscle weakness and wide purple striae
- Cardiovascular disease, thromboembolic disease, psychiatric and cognitive deficits, and infections
Diagnostic Evaluation
The evaluation of patients with suspected Cushing's syndrome requires an understanding of the proper use and limitations of diagnostic tests 4, 6. Some recommended tests include:
- 24-hour urine collection with analysis for urinary free cortisol excretion
- Low-dose and high-dose dexamethasone suppression tests
- Corticotropin assays, a corticotropin-releasing hormone stimulation test, and inferior petrosal sinus catheterization
- Magnetic resonance imaging to localize the lesion
Treatment
The treatment of Cushing's syndrome depends on the underlying cause and may involve surgery, medication, or radiation therapy 2, 3. Some treatment options include:
- Surgical removal of the source of excess endogenous cortisol production
- Medication such as adrenal steroidogenesis inhibitors, pituitary-targeted drugs, or glucocorticoid receptor blockers
- Radiation therapy and bilateral adrenalectomy for patients not responsive to surgery and medication