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Cushing's syndrome

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Endocrine System

From MayoClinic.com


Your endocrine system consists of glands that produce hormones that regulate processes throughout your body. They include the adrenal glands, pituitary gland, thyroid gland, parathyroid glands, pancreas, ovaries (in females) and testicles (in men).

Your adrenal glands produce a number of hormones, including cortisol, which plays a variety of roles in your body. For example, cortisol helps regulate your blood pressure and keeps your cardiovascular system functioning normally. It also helps your body respond to stress, and regulates the way you convert (metabolize) proteins, carbohydrates and fats in your diet into usable energy. However, when the level of cortisol is too high in your body, you may develop Cushing's syndrome.

Cushing's syndrome can develop from a cause that originates outside of your body (exogenous Cushing's syndrome). Taking certain medications over an extended period of time, such as corticosteroid medications by mouth, may cause your cortisol level to rise. That's because these medications are synthetic forms of cortisol. Your doctor may prescribe corticosteroids to treat inflammatory diseases such as rheumatoid arthritis, lupus, asthma and inflammatory bowel disease, or to prevent your body from rejecting a transplanted organ.

Commonly used corticosteroid drugs include:

  • Budesonide (Pulmicort, Rhinocort)

  • Dexamethasone (Decadron, Dexone)

  • Fluticasone (Flonase, Flovent)

  • Hydrocortisone (Cortef)

  • Methylprednisolone (Medrol)

  • Prednisone (Deltasone, Meticorten)

  • Triamcinolone (Aristocort, Kenacort)

People also commonly get Cushing's from injectable corticosteroids — for example, repeated injections for joint pain, bursitis and back pain. Although certain inhaled steroid medicines (taken for asthma) and steroid skin creams (for skin disorders such as eczema) are in the same general category of drugs, they rarely cause Cushing's syndrome.

The condition may also be due to your body's own overproduction of cortisol (endogenous Cushing's syndrome). This may occur from excess production by one or both adrenal glands, or overproduction of the adrenocorticotropic hormone (ACTH), which normally regulates cortisol production. In these cases, Cushing's syndrome may be related to:

  • Pituitary gland tumor. A noncancerous (benign) tumor of the pituitary gland, located on the bottom of the brain, secretes an excess amount of ACTH, which in turn stimulates the adrenal glands to make more cortisol. When this secondary form of the syndrome develops, it's called Cushing's disease rather than Cushing's syndrome. It occurs five times more often in women than in men, and is the most common form of endogenous Cushing's syndrome.

  • Ectopic ACTH-secreting tumor. Rarely, when a tumor develops in an organ that normally does not produce ACTH, the tumor will begin to secrete this hormone in excess, resulting in Cushing's syndrome. These tumors are usually found in the lung, pancreas or thyroid and can be benign or malignant.

  • Primary adrenal gland disease. In some people, the cause of Cushing's syndrome is excess cortisol secretion that doesn't depend on stimulation from ACTH and is associated with disorders of the adrenal glands. The most common of these disorders is a noncancerous tumor of the adrenal cortex, called an adrenal adenoma. Cancerous tumors of the adrenal cortex are rare, but they can cause Cushing's syndrome as well. Occasionally, benign, nodular enlargement of both adrenal glands can result in Cushing's syndrome.

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