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Cushing's syndrome results from prolonged exposure to excess cortisol.
Causes
Most commonly steroid medications. Endogenous causes include a pituitary adenoma (Cushing's disease, ~70%), adrenal tumours and ectopic ACTH secretion.
Signs
Rounded red face, central weight gain, thin limbs with muscle weakness, wide purple striae, easy bruising, hypertension, diabetes, osteoporosis, irregular periods, low mood and infections.
Diagnosis
After excluding steroid use: 1 mg dexamethasone suppression test, late-night salivary cortisol and 24-hour urinary free cortisol, followed by ACTH, further tests and pituitary or adrenal imaging.
Treatment
Gradual steroid tapering, transsphenoidal pituitary surgery, laparoscopic adrenalectomy, medication or radiotherapy. Temporary steroid replacement after surgery must be carefully managed — Dr. Demirci authored a chapter on peri-operative care in Cushing's syndrome.
Frequently asked questions
Could Cushing's be the cause of my weight gain?
It is rare and accounts for very few cases of obesity, but suspicious features warrant screening.
Content on this website is for information only and does not replace a medical consultation.
