Cushing's Syndrome: Recognising Chronic Cortisol Excess
Weight gain in unusual places and skin fragility are clues.
Dr. Camille Ferraud
Endocrinologist
In simple terms
Cushing's syndrome is rare but its features overlap with common conditions, delaying diagnosis by years.
What you need to remember
- Causes — Most cases are iatrogenic from glucocorticoid therapy.
- Diagnosis — hour urinary free cortisol, late-night salivary cortisol and overnight dexamethasone suppression test screen the syndrome.
- Treatment — Surgery of the underlying tumour is curative when feasible.
- Central obesity with thin limbs
- Moon face, buffalo hump
- Purple skin striae wider than 1 cm
- Easy bruising
- Proximal muscle weakness
- Hypertension and new-onset diabetes
Causes
Most cases are iatrogenic from glucocorticoid therapy. Endogenous causes include pituitary adenomas (Cushing's disease), adrenal tumours, and ectopic ACTH secretion.
Diagnosis
24-hour urinary free cortisol, late-night salivary cortisol and overnight dexamethasone suppression test screen the syndrome. Imaging localises the cause.
Treatment
Surgery of the underlying tumour is curative when feasible. Medical therapy (ketoconazole, metyrapone, osilodrostat) controls cortisol when surgery is delayed or incomplete.
Never abruptly stop long-term steroid therapy: adrenal insufficiency may follow.
The words explained
Medical terms used above, in everyday language.
- Diagnosis
- The moment a doctor identifies which illness is causing your symptoms.
- Blood pressure
- The force of blood pushing against your artery walls. Too high, over years, damages the heart and vessels.
When should you see a doctor?
- Your symptoms last more than a few weeks or keep coming back.
- They get worse quickly, or stop you doing everyday things.
- You notice sudden pain, breathing trouble, fainting or bleeding — seek urgent care.
- You already take medication and want to change anything about it.
This article explains general health information. It does not replace advice from your own doctor.
Frequently asked questions
- What is Cushing's Syndrome: Recognising Chronic Cortisol Excess?
- Cushing's syndrome is rare but its features overlap with common conditions, delaying diagnosis by years.
- What are the main symptoms or signs of Cushing's Syndrome: Recognising Chronic Cortisol Excess?
- Common signs vary from person to person. The article above lists the symptoms to watch for, how they progress, and when they need medical attention.
- When should you see a doctor for Cushing's Syndrome: Recognising Chronic Cortisol Excess?
- See a doctor if symptoms last more than a few weeks, get worse quickly, stop you doing everyday things, or if you notice sudden pain, breathing trouble, fainting or bleeding.
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