CushingSyndrom

Cushing syndrome is a hormonal disorder caused by prolonged exposure to elevated cortisol levels. It can be endogenous, due to internal overproduction of cortisol or adrenocorticotropic hormone (ACTH), or exogenous, resulting from external glucocorticoid therapy.

Endogenous Cushing syndrome is subdivided into ACTH-dependent forms, such as Cushing disease from a pituitary ACTH-secreting adenoma and ectopic ACTH production from tumors, and ACTH-independent forms due to cortisol-producing adrenal adenomas or carcinomas.

Common signs include weight gain with central obesity, facial rounding (moon face), a dorsocervical fat pad (buffalo hump), abdominal striae, thin skin and easy bruising, proximal muscle weakness, hypertension, glucose intolerance, and osteoporosis. Mood changes and menstrual disturbances may occur.

Diagnosis typically starts with evidence of hypercortisolism: elevated 24-hour urinary free cortisol, or insufficient suppression with an overnight 1 mg dexamethasone test, or abnormal late-night salivary cortisol. After confirmation, ACTH measurement helps distinguish ACTH-dependent from ACTH-independent disease, with pituitary MRI and adrenal/ectopic imaging as indicated.

Treatment targets the underlying cause: pituitary surgery for Cushing disease, adrenalectomy for adrenal tumors, and tumor-directed therapy for ectopic ACTH secretion. When surgery is not possible, medical therapies that reduce cortisol production (eg, ketoconazole, metyrapone, osilodrostat) or glucocorticoid-receptor antagonists (mifepristone) may be used.

Prognosis improves with effective treatment, but cardiovascular, metabolic, and infectious risks may persist after cure. The condition is relatively rare, most commonly affects adults, with a female predominance; iatrogenic Cushing syndrome from prescribed steroids remains the most frequent form.