Endocrine Disorders Endocrine Disorder Basics

Finding Your Way Through Complicated Cushing's Syndrome

Cushing's syndrome is a rare, but complex disorder affecting many aspects of the body. It may be caused by certain medications you are taking, or from a tumor that alters the production of cortisol, a hormone associated with stress. If left untreated, it can lead to a host of problems including osteoporosis, high blood pressure and muscle loss. Finding the cause of your Cushing's syndrome is the key to finding the proper treatment.

How does a doctor determine the source of the disease? Dr. Elena Plummer, MD, a member of the American Association of Clinical Endocrinologists (AACE) and the Endocrine Society outlines the potential causes of this syndrome and what treatment options are available to help.

What is Cushing's syndrome?
Cushing's syndrome develops from excess cortisol, a steroid, that's either ingested exogenously, from the outside, or produced endogenously, within the body. Cushing's syndrome is an umbrella name for all the conditions including high cortisol level and its manifestations.

It is a very rare problem. There are anywhere from 5 to 25 cases per million per year. It is more common in females than in males and is generally a disease of women between 20 and 45 years of age.

What is the function of cortisol in a healthy person?
There is no one main function of cortisol and researchers have found that just about any part of the body is regulated by cortisol. It's a hormone that regulates many activities; glucose metabolism, the immune system, the metabolism of calcium and bone metabolism. And too much (Cushing's syndrome) or too little (Addison's disease), is detrimental. Addison's disease causes the opposite effects of Cushing's syndrome: blood pressure is too low, electrolytes are abnormal, potassium is high, patients lose weight and are very fatigued.

What controls cortisol production?
There is a small gland in the middle of the brain called the pituitary gland that makes several stimulating hormones that go on to regulate the production other hormones. For example, there's a hormone called thyroid-stimulating hormone (TSH) in the pituitary that goes and tells your thyroid how much to work. The same thing happens with the adrenal gland. There is a hormone in the pituitary called adrenocorticotropic-stimulating hormone (ACTH) that stimulates cortisol production in the adrenal gland. So in a healthy person there is generally a small amount of ACTH, causing the production of a small amount of cortisol.

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