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Cushing's Syndrome

Cushing’s syndrome is the clinical state caused by prolonged excessive cortisol exposure, whether from prescribed corticosteroids or internal overproduction.

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Key takeaways

  • Easy bruising, wide purple stretch marks, proximal muscle weakness, diabetes and high blood pressure together raise suspicion more than weight gain alone.
  • Diagnosis requires carefully selected cortisol tests because stress, sleep disruption, alcohol and some medicines can create misleading results.
  • Treatment targets the source; abruptly stopping long-term corticosteroids can cause dangerous adrenal insufficiency.

The listings below do not confirm cortisol excess or its cause; endocrinology assessment and monitoring are required.

Confirming excess and finding the source

Late-night salivary cortisol, overnight dexamethasone suppression or 24-hour urinary free cortisol may be used, usually with confirmation. ACTH then helps separate pituitary or ectopic production from an adrenal cause, followed by targeted imaging. Imaging alone can mislead because incidental nodules are common.

Treatment decisions

Gradual supervised reduction is used when prescribed corticosteroid is responsible. Surgery is often preferred for a resectable hormone-producing tumour. Cortisol-blocking medicines can bridge to surgery or treat persistent disease but need monitoring for liver effects, low cortisol, potassium and interactions.

When to seek urgent care

Seek urgent care for severe infection, chest pain, sudden breathlessness, confusion, severe weakness, uncontrolled high blood pressure or repeated vomiting after reducing corticosteroid treatment.