Cushing's syndrome

Cushing's syndrome is a condition caused by long-term elevated levels of the hormone cortisol in the body. It can result from the overproduction of cortisol directly in the adrenal glands or arise secondarily—for example, due to the production of adrenocorticotropic hormone (ACTH) in the pituitary gland or other tumors.

Typical symptoms

  • Obesity with characteristic fat deposits in the torso, face (“moon face”), and neck area
  • Thin skin that bruises easily, purple stretch marks (especially in the armpits)
  • Muscle weakness, particularly in the limbs
  • High blood pressure and glucose intolerance or diabetes
  • Menstrual irregularities in women, decreased libido, osteoporosis
  • Psychological changes: irritability, depression, sleep disorders

Diagnostics

Diagnosing Cushing's syndrome is complex and involves multiple steps. First, it must be confirmed that cortisol levels in the body are indeed elevated:

  • 1 mg dexamethasone suppression test — verification of whether the body suppresses cortisol production after the drug is administered; additional specialized tests may also be used
  • Measurement of free cortisol in urine (24-hour collection)
  • Late-night salivary cortisol test
  • Measurement of ACTH in the blood

Once elevated cortisol levels are confirmed, the source is investigated using imaging methods (CT/MRI of the adrenal glands or pituitary gland) and potentially other tests.

Not sure how to proceed?

Every health problem has its own context. If you are hesitant about what is best for you, arrange a consultation. Our doctors will walk you through the situation and recommend a course of action that makes sense — professionally, sensitively, without unnecessary stress.

Causes and classification

Cushing's syndrome can be:

  • ACTH-dependent: Cortisol is produced due to increased ACTH levels (e.g., Cushing's disease — pituitary adenoma; or ectopic ACTH production from another tumor)
  • ACTH-independent: The adrenal gland itself produces an excess of cortisol (e.g., adenoma, carcinoma, or bilateral hyperplasia)

In rare cases, the disease can be part of genetic syndromes.

Treatment

The basis of treatment is always the elimination of the source of cortisol overproduction:

  • For adrenal or pituitary adenomas — surgical removal
  • In some cases (e.g., an unlocalized ectopic ACTH source), it may be necessary to perform a bilateral adrenalectomy
  • In advanced disease — medications that block cortisol production (e.g., ketoconazole, metyrapone)
  • In aggressive or malignant forms — oncological treatment

Monitoring and long-term care

After surgery, hormone levels must be monitored and cortisol replacement therapy adjusted. In some patients, metabolic or psychological changes persist even after a cure.

Patients are monitored by our multidisciplinary team — endocrinologist, surgeon, and potentially an oncologist and psychologist.

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