Cushing syndrome: Signs, symptoms and treatment

[5 MIN READ]

In this article:

• Cushing syndrome can develop when your body has too much cortisol. This can be either because of a tumor or because of the side effects of a medication you are taking.

• It’s especially hard to diagnose, because many of the symptoms for Cushing syndrome are similar to symptoms of other conditions. 

• While Cushing syndrome is curable, it may be a lifelong disorder if it is caused by certain medications that you absolutely must take for other conditions, or by a tumor that cannot be removed by surgery.

Cushing syndrome: Signs, symptoms and treatments

In early 2024, the rare hormonal disorder Cushing syndrome made headlines when comedian Amy Schumer revealed she suffered from it. Since then, the disorder has been trending as more people have been taking medications that could cause it to surface.

We talked with Providence endocrinologist Chih-Han Lee, M.D., who sees patients in Burbank, California, about Cushing syndrome and why it can be concerning. 

What is Cushing syndrome?

Cushing syndrome occurs when your body has been exposed to large amounts of cortisol over a long period of time. Cortisol is a hormone that your body releases during times of stress, increasing your heart rate, blood pressure and muscle tension.

There are two main causes of Cushing syndrome:

• Endogenous is when the causes come from within your body — typically a tumor.
• Exogenous is when you develop the disorder because of the side effects of medications, such as prednisone, that you take to treat other conditions. This is the type of Cushing syndrome that Schumer has.

Signs and symptoms of Cushing syndrome

Some of the main symptoms of Cushing syndrome include:

• Unexpected weight gain, especially around the belly
• Irregular menstrual cycles
• Muscle weakness
• Fractures
• Feeling tired
• Bruising easily
• A red, round and puffy face
• Fat deposits behind and in front of the neck
• Wide purple stretch marks on the belly
• High blood pressure
• High blood sugar

In addition to the physical signs, Cushing syndrome can also lead to psychological symptoms, including:

• Depression
• Anxiety
• Irritability
• Cognitive impairment
• Mood and behavior disorders

How is Cushing syndrome diagnosed?

According to Dr. Lee, Cushing syndrome can be hard to diagnose because symptoms vary, and can range from mild to severe, depending on how much extra cortisol is in the body.

“We can make a diagnosis when a person shows signs and symptoms of the condition and lab tests confirm high levels of cortisol,” Dr. Lee says. “However, several other conditions, such as obesity, pregnancy, severe stress, poorly controlled diabetes, eating disorders, depression, alcoholism, polycystic ovary syndrome (PCOS), sleep apnea, chronic kidney disease and certain medications, can also raise cortisol levels. Because of these conditions, testing for Cushing's syndrome is recommended when there is a strong suspicion for it.” 

Common tests to check cortisol levels include:

• Dexamethasone suppression test – you take a dose of the substance dexamethasone, and then you have a blood sample taken the next morning to measure the amount of cortisol in your blood
• Late-night salivary cortisol – measures the amount of cortisol in a saliva sample taken late at night
• Late-night blood cortisol – measures the amount of cortisol in a blood sample taken late at night
• 24-hour urine cortisol – you collect urine in a container for 24 hours

Your doctor can confirm a diagnosis of Cushing syndrome when cortisol levels are high on at least two of these tests, and you also have symptoms.

Treatment options for Cushing syndrome

Treatment for Cushing syndrome, says Dr. Lee, depends on the cause. “It can be caused by corticosteroid medications, a tumor in the adrenal or pituitary glands, or a tumor outside these glands that produces too much ACTH (a hormone that signals the body to make cortisol),” says Dr. Lee. “If corticosteroid medications are the cause, lowering the dose or slowly stopping the medication may help. If a tumor is the cause, surgery to remove the tumor is often the best treatment.”

If you need to wait for surgery, or if it’s not possible, you can use medications to lower your cortisol level.

Cushing syndrome can be cured, but if the tumor cannot be removed, then it may become a long-term condition. Some people develop the disorder because they need corticosteroid medications for other conditions, such as autoimmune or inflammatory diseases, or to prevent organ rejection after a transplant. If they need high doses of corticosteroid medications for a long time, they might develop Cushing syndrome, which could be lifelong if the medication dose cannot be lowered.

When to see a doctor for Cushing syndrome

If you notice any of the above signs and symptoms of Cushing syndrome, you should see your doctor as soon as possible. 

“Since many other conditions can also raise cortisol levels,” says Dr. Lee, “testing should only be done if there is a strong reason to suspect Cushing syndrome based on your symptoms, medical history and a physical exam.” 

If you don’t get the right treatment for Cushing syndrome, it can cause multiple complications, including:

• Type 2 diabetes
• High blood pressure, which can lead to heart problems and other serious issues
• Loss of muscle mass and strength
• Osteoporosis
• Infections

You can find treatment for Cushing syndrome and other similar conditions at the Providence Brain and Spine Institute.

Contributing caregivers

Chih-Han Lee, M.D., is a Providence endocrinologist who sees patients in Burbank, California.

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This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.