From the Guidelines
Cushing's syndrome is a medical condition caused by excessive levels of cortisol, a stress hormone, in the body over an extended period, and it is crucial to diagnose and treat it promptly to prevent serious complications, as stated in the most recent guideline update 1.
Definition and Causes
Cushing's syndrome can result from taking high doses of corticosteroid medications like prednisone, or from the body producing too much cortisol due to a tumor in the pituitary gland (Cushing's disease), adrenal glands, or elsewhere. Some key points to consider are:
- Elevated levels of cortisol are indicative of Cushing syndrome, as noted in a study on neuroendocrine tumors 1.
- Symptoms include weight gain, purple stretch marks, thin skin that bruises easily, muscle weakness, high blood pressure, high blood sugar, excessive hair growth in women, and mood changes.
Diagnosis and Treatment
Diagnosis typically involves:
- Blood and urine tests to measure cortisol levels
- Imaging studies to locate potential tumors Treatment depends on the cause but may include:
- Surgery to remove tumors
- Radiation therapy
- Medications like ketoconazole, mitotane, or mifepristone to reduce cortisol production
- Gradually reducing the dose of corticosteroid medications under medical supervision, if applicable According to a recent consensus on diagnosis and management of Cushing's disease, accurate diagnosis, careful treatment selection, and long-term management are necessary to optimize patient outcomes 1.
Importance of Prompt Treatment
Without treatment, Cushing's syndrome can lead to serious complications, including:
- Diabetes
- Bone loss
- Increased infections
- Cardiovascular problems Therefore, it is essential to prioritize the diagnosis and treatment of Cushing's syndrome to improve patient outcomes and quality of life, as emphasized in the latest clinical guidelines 1.
From the FDA Drug Label
Mifepristone is a prescription medicine used to treat high blood sugar (hyperglycemia) caused by high cortisol levels in the blood (hypercortisolism) in adults with endogenous Cushing's syndrome Cushing's syndrome manifestations such as cushingoid appearance, acne, hirsutism, striae, psychiatric symptoms, and excess total body weight Cushing's Syndrome is a condition characterized by high cortisol levels in the blood, leading to various symptoms such as:
- Cushingoid appearance
- Acne
- Hirsutism
- Striae
- Psychiatric symptoms
- Excess total body weight It is caused by endogenous hypercortisolism, which can be due to various reasons, including failed surgery, recurrence of disease, and poor medical candidate for surgery 2 2.
From the Research
Definition and Causes of Cushing Syndrome
- Cushing syndrome is defined as a prolonged increase in plasma cortisol levels that is not due to a physiological etiology 3.
- The most frequent cause of Cushing syndrome is exogenous steroid use, but the estimated incidence of Cushing syndrome due to endogenous overproduction of cortisol ranges from 2 to 8 per million people annually 3.
- Cushing disease, in which corticotropin excess is produced by a benign pituitary tumor, occurs in approximately 60% to 70% of patients with Cushing syndrome due to endogenous cortisol production 3.
Symptoms and Diagnosis of Cushing Syndrome
- Cushing syndrome is associated with hyperglycemia, protein catabolism, immunosuppression, hypertension, weight gain, neurocognitive changes, and mood disorders 3.
- Characteristic presentations include skin changes such as facial plethora, easy bruising, and purple striae, as well as metabolic manifestations like hyperglycemia, hypertension, and excess fat deposition in the face, back of the neck, and visceral organs 3.
- Evaluation of patients with possible Cushing syndrome begins with ruling out exogenous steroid use, followed by screening for elevated cortisol using a 24-hour urinary free cortisol test, late-night salivary cortisol test, or dexamethasone suppression test 3.
Treatment and Management of Cushing Syndrome
- First-line therapy for Cushing syndrome due to endogenous overproduction of cortisol is surgery to remove the causative tumor 3, 4.
- Adrenally directed medical therapies, such as ketoconazole, metyrapone, osilodrostat, mitotane, and etomidate, can be used to inhibit adrenal steroidogenesis in patients who cannot undergo surgery or have persistent hypercortisolism postoperatively 5.
- Radiation therapy and bilateral adrenalectomy may be considered for patients who do not respond to surgery and medication 3, 6, 7.
- Lifelong posttherapy monitoring is required to treat comorbidities and detect recurrence 4.