Title
Subscribe to the Magazine for free
Subscribe for free to keep reading! If you are already subscribed, enter your email address to log back in.
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
Are you a healthcare practitioner?
Thanks for subscribing!
Oops! Something went wrong while submitting the form.

Symptoms of Cushing’s Disease and When to See Your Doctor

Why This Was Updated?

Our specialists regularly review advancements in health and wellness, ensuring our articles are updated with the newest information as it becomes accessible.
Medically Reviewed by

​​Cushing's disease is a rare hormonal disorder caused by excessive cortisol production, often due to a benign pituitary tumor. This leads to symptoms like weight gain, high blood pressure, and mood changes. Early detection is essential for effective treatment and reducing the risk of complications like cardiovascular disease and osteoporosis.

Cushing's disease can look like other, more common conditions, including diabetes or cardiovascular disease, so medical providers need to be aware of it and know when to refer for proper symptom assessment, diagnosis, and treatment.

This article covers the symptoms of Cushing's Disease and the importance of seeking prompt medical attention. The goal is to encourage early diagnosis and improve patient outcomes.

[signup]

Understanding Cushing's Disease

Cushing's disease is the second most common cause of Cushing's syndrome

While Cushing's disease is a relatively rare endocrine disease, recognizing the signs and providing the proper medical attention can save lives. 

What is Cushing's Disease?

Cushing's disease is an endocrine disorder caused by excessive production of adrenocorticotropic hormone (ACTH), usually due to a benign pituitary tumor, often a small pituitary microadenoma (a tumor smaller than 10 mm). 

Pathophysiologically, the elevated ACTH in Cushing's disease disrupts the normal circadian rhythm of cortisol production, resulting in persistently high cortisol levels. This causes both glucocorticoid and mineralocorticoid effects that result in serious complications that can be missed in the early stages. 

Cushing's disease, the second most common form of Cushing's syndrome, typically goes undiagnosed for 3 to 6 years. It mainly affects women aged 30-60 [4, 71].

With a mortality rate of 10-11%, untreated Cushing's disease increases the risk of cardiovascular issues, infections, and mental health disorders. 

Effective treatment requires a multidisciplinary approach, including surgery, medication, and ongoing monitoring to manage the complex symptoms.

The Impact of Elevated Cortisol on the Body

Cortisol, a glucocorticoid hormone, is normally important in various processes, such as metabolism, immune response, and stress management.

However, in Cushing's disease, the chronic elevation of cortisol disrupts normal physiological functions, causing the characteristic symptoms of Cushing's disease.

Excess cortisol in Cushing's disease has both glucocorticoid and mineralocorticoid effects. 

Many of the glucocorticoid effects of excess cortisol include:

Excess cortisol's glucocorticoid and mineralocorticoid effects contribute to hypertension, sodium retention, and potassium depletion. 

Cushing's disease is also associated with neuropsychiatric and cognitive symptoms due to prolonged exposure to high levels of cortisol. Symptoms can include emotional instability, depression, anxiety, impulsivity, and cognitive deficits.

How is Cushing's Disease Different Than Cushing's Syndrome?

Cushing's syndrome is the broad term for prolonged exposure to high cortisol levels, often due to long-term corticosteroid use (iatrogenic) or, less commonly, from the body's overproduction of cortisol (endogenous). 

Cushing's disease is a subtype of Cushing's syndrome. It is caused by a pituitary adenoma, which accounts for 80% of endogenous cases. 

Who is at Risk for Cushing's Disease?

The most common cause of Cushing's syndrome is the use of corticosteroid medications [5, 68]. 

Cushing's disease, as a subtype of Cushing's syndrome, is less commonly diagnosed. Women are at a higher risk for Cushing's disease, being up to eight times more likely than men to develop Cushing's disease. The peak incidence of Cushing's syndrome occurs in adults aged 25-40.

Common Symptoms of Cushing's Disease

While the variability and subtlety of symptoms can make diagnosis challenging, Cushing's disease has several hallmark symptoms. These symptoms and the mechanisms behind their development in Cushing's disease are discussed below.

Weight Gain and Fat Distribution

Cushing's Disease leads to weight gain and abnormal fat distribution:

Central Obesity

In Cushing's disease, high levels of cortisol cause fat to accumulate in central areas like the abdomen, trunk, and face, leading to characteristic features such as abdominal weight gain,  "moon face," and "buffalo hump." 

Cortisol promotes fat storage by converting sugars into fat while slowing down fat breakdown, especially in these central regions.

The exact mechanism is complex and involves cortisol's action on various enzymes and hormones that regulate fat metabolism and distribution, but it directs fat accumulation in central areas.

Fat Pads

Just as patients with Cushing's disease develop characteristic central obesity and moon face, they can also develop fat pads on the back of their neck, upper back, and shoulders, also known as "buffalo hump." 

But while the buffalo hump can occur in Cushing's syndrome, it is also seen in other conditions such as obesity and type 2 diabetes, so it is not considered a specific symptom of Cushing's disease. 

Therefore, a comprehensive evaluation, including biochemical tests, is needed to confirm the diagnosis.

Skin Changes

Cushing's Disease also leads to skin changes:

Thinning Skin

Cortisol has a strong impact on skin structure and growth, primarily because its receptors are mostly found in the deeper layers of the skin. 

Excess cortisol disrupts the production of key factors for skin health, including collagen, which maintains skin thickness and promotes healing. 

As a result, the skin becomes thinner, wounds heal more slowly, and overall, the skin becomes more fragile and prone to atrophy.

Purple Stretch Marks (Striae)

Pink or purple stretch marks can appear on the body in Cushing's disease, often across the belly, thighs, breasts, and buttocks, and in other places where the skin can stretch.

Excess cortisol suppresses collagen synthesis, weakening the skin's structure. This weakening, combined with stretching forces accompanying weight gain, forms these characteristic striae.

Acne and Increased Hair Growth

In Cushing's syndrome, facial acne and hirsutism (excess hair growth) are linked to increased adrenal androgens and cortisol secretion. 

Women and prepubertal children with Cushing's syndrome often develop fine, downy facial hair, in addition to acne and hirsutism, and may also experience hair thinning at the temples. 

Muscle Weakness and Fatigue

While Cushing's disease causes central weight gain, it also causes muscle wasting and weakness in the limbs, which can cause the individual to develop a large belly with much thinner arms and legs. 

This is due to the complex interplay of glucocorticoid functions. High levels of cortisol (glucocorticoids) contribute to muscle wasting by disrupting the balance between muscle protein synthesis and degradation. 

Cortisol inhibits protein synthesis while enhancing protein breakdown, a key mechanism in muscle atrophy. Cortisol also upregulates transcription factors that contribute to increased muscle protein degradation. 

Mood Changes

Cortisol has powerful effects on mood and cognitive function due to the abundance of glucocorticoid receptors in the brain, especially those in the limbic region. 

Excess cortisol is thought to affect the hippocampus, a brain region involved in mood regulation and memory, which leads to structural changes like hippocampal volume loss, decreased neurogenesis, and brain atrophy.  

Depression and Anxiety

The pathophysiology of cortisol's effects on mood involves dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis.

Elevated cortisol levels and HPA axis dysregulation are associated with depressive symptoms, anxiety, and cognitive deficits, likely due to cortisol's neurotoxic effects on the brain. 

Cognitive Impairment

Chronic exposure to elevated cortisol levels in Cushing's disease is associated with cognitive deficits, particularly in verbal learning, memory, and visual-spatial processing

Excessively high cortisol levels have been associated with more rapid cognitive aging.

High Blood Pressure

High cortisol in Cushing's disease causes hypertension through multiple pathways involving both glucocorticoid and mineralocorticoid functions.

Cortisol raises plasma and extracellular fluid volumes, heightens the body's responsiveness to catecholamines, and contributes to elevated blood pressure. It also impacts the renin-angiotensin system by reducing plasma renin and angiotensin II levels while increasing sensitivity to pressor effects.

Cortisol also inhibits nitric oxide, a vasodilator.

Each of these mechanisms is thought to contribute to the hypertension often seen in Cushing's disease. 

Bone Health Issues

Osteoporosis

High levels of glucocorticoids commonly lead to secondary osteoporosis through several mechanisms. 

For example, excess glucocorticoids increase bone resorption while decreasing bone formation. They also impair calcium absorption in the intestines and increase calcium excretion through urine, which then causes a compensatory rise in parathyroid hormone (PTH) levels. 

Elevated PTH further stimulates bone resorption, exacerbating bone loss and osteoporosis

Back Pain

Back pain can be a common complaint among those suffering from Cushing's disease. This is primarily due to the influence of the osteoporotic process

Osteoporosis significantly increases the risk of vertebral fractures. These fractures are common and can cause spinal deformities and imbalance, leading to chronic back pain. When multiple vertebral fractures occur, they can cause a kyphotic deformity, leading to further pain and disability. 

Reproductive and Sexual Health Symptoms

Reproductive and sexual health symptoms are also common amongst this population:

Menstrual Irregularities

In up to 80% of cycling women with Cushing's disease, menstrual irregularities, including oligomenorrhea (irregular periods), amenorrhea (no periods in premenopausal women), and polymenorrhea (more frequent periods), can occur. 

This is due to the complex relationship between cortisol and female and male reproductive hormones. High cortisol levels can impair normal hypothalamic-pituitary-gonadal (HPG) axis function, causing a range of upsetting menstrual changes.

It does this in part by interfering with the secretion of gonadotropin-releasing hormone (GnRH) from the hypothalamus, leading to disruptions in the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are essential for normal ovarian function and menstrual regularity

Erectile Dysfunction

Up to 69% of men with endogenous hypercortisolism, as in Cushing's disease, report decreased libido. This condition may also lead to erectile dysfunction, although the exact prevalence of ED in these patients is not fully known.

Several mechanisms may contribute to this, including:

  • Disruption of the hypothalamic-pituitary-gonadal (HPG) axis, which may reduce testosterone production
  • A direct negative impact of high cortisol on sexual function (cortisol levels typically decline with the initiation of penile erection)
  • Metabolic conditions like diabetes, obesity, and hypertension which can all impact erectile function

Less Common But Noteworthy Symptoms

While these aren't the most common, they are still important to explore and understand:

Increased Thirst and Urination

People with Cushing's disease can present with polyuria (excessive urination) and polydipsia (excessive thirst), contributing to a clinical picture that may be mistaken for diabetes.

These symptoms are typical in Cushing's due to the body's response to prolonged exposure to high cortisol levels, which can disrupt normal fluid balance and increase thirst and urination.

Headaches and Visual Disturbances

Cushing's disease is most often linked to small brain tumors known as pituitary microadenomas (tumors smaller than 10 mm), which typically do not cause headaches or visual disturbances.

While visual disturbances are often expected with larger pituitary adenomas, this finding in Cushing's disease is rare.

However, headaches and visual disturbances may occasionally be seen in Cushing's disease. Because large brain tumors in Cushing's disease are uncommon, intracranial hypertension should be considered as a cause for these symptoms.

Decreased Immunity

Elevated cortisol levels in Cushing's syndrome cause a profound immune system suppression, impacting all immune cell types. 

This suppression involves increased cell death, disrupted immune regulation, and weakened responses, making patients more prone to infections, including viral and opportunistic ones. 

Cortisol-induced lymphopenia, or decreased white blood cell counts, further increases infection susceptibility. This decreased immune function, combined with thinning skin, also contributes to slower wound healing.

Unusual Fatigue Despite Rest

Cortisol is closely linked with energy metabolism. High cortisol levels have been linked to fatigue.

When to See Your Doctor

Cushing's disease can be mistaken for other conditions. If you're feeling unwell, it's essential to consult your doctor for evaluation and treatment.

Recognizing the Symptoms

Unexplained weight gain, muscle weakness, high blood pressure, or mood changes should not be ignored. These could signal Cushing's Disease or another endocrine or metabolic issue. 

Because these symptoms can be subtle and worsen over time, it's essential to seek medical advice if they persist.

Importance of Early Medical Consultation

Early diagnosis is crucial in managing Cushing's disease effectively. Prompt medical consultation can stop symptom progression and reduce the risk of serious complications.

If your symptoms persist or worsen, don't delay seeking medical help—early intervention can significantly improve your quality of life.

Diagnostic Process

Expect a thorough diagnostic process, including a physical exam, hormone assessments, and possibly imaging studies like CT scans or MRIs. These tests help confirm the diagnosis and guide the treatment plan.

Who to See

Consult an endocrinologist for diagnosis and management of Cushing's Disease. These specialists are experts in hormone-related disorders and can provide the precise care you need. Early referral to a specialist ensures a more accurate diagnosis and tailored treatment.

[signup]

Key Takeaways

  • Cushing's disease is a severe but rare hormonal disorder caused by excessive cortisol due to a pituitary adenoma. 
  • Symptoms include unexplained weight gain, muscle weakness, high blood pressure, mood changes, and skin changes. Early detection for effective treatment and reducing complications like cardiovascular issues, osteoporosis, and cognitive problems is important.
  • While rare, Cushing's disease is an important condition for medical providers to identify and refer to the proper specialists.
  • If you have persistent symptoms, consult a healthcare provider promptly. Early intervention can lead to quicker diagnosis and treatment, preventing disease progression and minimizing long-term risks.
  • With timely treatment, Cushing's disease symptoms can be managed, significantly improving quality of life. Stay hopeful and proactive in seeking medical advice, as early intervention can lead to successful outcomes.

​​Cushing's disease is a rare hormonal disorder caused by excessive cortisol production, often due to a benign pituitary tumor. This can lead to symptoms like weight gain, high blood pressure, and mood changes. Early detection is important for managing symptoms and reducing the risk of complications like cardiovascular issues and bone health concerns.

Cushing's disease can resemble other, more common conditions, including diabetes or cardiovascular disease, so medical providers need to be aware of it and know when to refer for proper symptom assessment and management.

This article covers the symptoms of Cushing's Disease and the importance of seeking prompt medical attention. The goal is to encourage early diagnosis and improve patient outcomes.

[signup]

Understanding Cushing's Disease

Cushing's disease is the second most common cause of Cushing's syndrome

While Cushing's disease is a relatively rare endocrine disease, recognizing the signs and providing the proper medical attention can be crucial for health outcomes. 

What is Cushing's Disease?

Cushing's disease is an endocrine disorder caused by excessive production of adrenocorticotropic hormone (ACTH), usually due to a benign pituitary tumor, often a small pituitary microadenoma (a tumor smaller than 10 mm). 

Pathophysiologically, the elevated ACTH in Cushing's disease affects the normal circadian rhythm of cortisol production, resulting in persistently high cortisol levels. This can cause both glucocorticoid and mineralocorticoid effects that may lead to serious complications if not addressed early. 

Cushing's disease, the second most common form of Cushing's syndrome, often goes undiagnosed for 3 to 6 years. It mainly affects women aged 30-60 [4, 71].

With a mortality rate of 10-11%, untreated Cushing's disease may increase the risk of cardiovascular issues, infections, and mental health disorders. 

Effective management requires a multidisciplinary approach, including surgery, medication, and ongoing monitoring to address the complex symptoms.

The Impact of Elevated Cortisol on the Body

Cortisol, a glucocorticoid hormone, is normally important in various processes, such as metabolism, immune response, and stress management.

However, in Cushing's disease, the chronic elevation of cortisol can disrupt normal physiological functions, contributing to the characteristic symptoms of Cushing's disease.

Excess cortisol in Cushing's disease has both glucocorticoid and mineralocorticoid effects. 

Many of the glucocorticoid effects of excess cortisol may include:

Excess cortisol's glucocorticoid and mineralocorticoid effects may contribute to hypertension, sodium retention, and potassium depletion. 

Cushing's disease is also associated with neuropsychiatric and cognitive symptoms due to prolonged exposure to high levels of cortisol. Symptoms can include emotional instability, depression, anxiety, impulsivity, and cognitive deficits.

How is Cushing's Disease Different Than Cushing's Syndrome?

Cushing's syndrome is the broad term for prolonged exposure to high cortisol levels, often due to long-term corticosteroid use (iatrogenic) or, less commonly, from the body's overproduction of cortisol (endogenous). 

Cushing's disease is a subtype of Cushing's syndrome. It is caused by a pituitary adenoma, which accounts for 80% of endogenous cases. 

Who is at Risk for Cushing's Disease?

The most common cause of Cushing's syndrome is the use of corticosteroid medications [5, 68]. 

Cushing's disease, as a subtype of Cushing's syndrome, is less commonly diagnosed. Women are at a higher risk for Cushing's disease, being up to eight times more likely than men to develop Cushing's disease. The peak incidence of Cushing's syndrome occurs in adults aged 25-40.

Common Symptoms of Cushing's Disease

While the variability and subtlety of symptoms can make diagnosis challenging, Cushing's disease has several hallmark symptoms. These symptoms and the mechanisms behind their development in Cushing's disease are discussed below.

Weight Gain and Fat Distribution

Cushing's Disease can lead to weight gain and abnormal fat distribution:

Central Obesity

In Cushing's disease, high levels of cortisol may cause fat to accumulate in central areas like the abdomen, trunk, and face, leading to characteristic features such as abdominal weight gain,  "moon face," and "buffalo hump." 

Cortisol may promote fat storage by converting sugars into fat while slowing down fat breakdown, especially in these central regions.

The exact mechanism is complex and involves cortisol's action on various enzymes and hormones that regulate fat metabolism and distribution, but it directs fat accumulation in central areas.

Fat Pads

Just as patients with Cushing's disease may develop characteristic central obesity and moon face, they can also develop fat pads on the back of their neck, upper back, and shoulders, also known as "buffalo hump." 

But while the buffalo hump can occur in Cushing's syndrome, it is also seen in other conditions such as obesity and type 2 diabetes, so it is not considered a specific symptom of Cushing's disease. 

Therefore, a comprehensive evaluation, including biochemical tests, is needed to confirm the diagnosis.

Skin Changes

Cushing's Disease can also lead to skin changes:

Thinning Skin

Cortisol has a strong impact on skin structure and growth, primarily because its receptors are mostly found in the deeper layers of the skin. 

Excess cortisol may disrupt the production of key factors for skin health, including collagen, which maintains skin thickness and promotes healing. 

As a result, the skin may become thinner, wounds may heal more slowly, and overall, the skin may become more fragile and prone to atrophy.

Purple Stretch Marks (Striae)

Pink or purple stretch marks can appear on the body in Cushing's disease, often across the belly, thighs, breasts, and buttocks, and in other places where the skin can stretch.

Excess cortisol may suppress collagen synthesis, weakening the skin's structure. This weakening, combined with stretching forces accompanying weight gain, forms these characteristic striae.

Acne and Increased Hair Growth

In Cushing's syndrome, facial acne and hirsutism (excess hair growth) are linked to increased adrenal androgens and cortisol secretion. 

Women and prepubertal children with Cushing's syndrome often develop fine, downy facial hair, in addition to acne and hirsutism, and may also experience hair thinning at the temples. 

Muscle Weakness and Fatigue

While Cushing's disease may cause central weight gain, it can also cause muscle wasting and weakness in the limbs, which can cause the individual to develop a large belly with much thinner arms and legs. 

This is due to the complex interplay of glucocorticoid functions. High levels of cortisol (glucocorticoids) may contribute to muscle wasting by disrupting the balance between muscle protein synthesis and degradation. 

Cortisol may inhibit protein synthesis while enhancing protein breakdown, a key mechanism in muscle atrophy. Cortisol also upregulates transcription factors that contribute to increased muscle protein degradation. 

Mood Changes

Cortisol has powerful effects on mood and cognitive function due to the abundance of glucocorticoid receptors in the brain, especially those in the limbic region. 

Excess cortisol is thought to affect the hippocampus, a brain region involved in mood regulation and memory, which may lead to structural changes like hippocampal volume loss, decreased neurogenesis, and brain atrophy.  

Depression and Anxiety

The pathophysiology of cortisol's effects on mood involves dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis.

Elevated cortisol levels and HPA axis dysregulation are associated with depressive symptoms, anxiety, and cognitive deficits, likely due to cortisol's neurotoxic effects on the brain. 

Cognitive Impairment

Chronic exposure to elevated cortisol levels in Cushing's disease is associated with cognitive deficits, particularly in verbal learning, memory, and visual-spatial processing

Excessively high cortisol levels have been associated with more rapid cognitive aging.

High Blood Pressure

High cortisol in Cushing's disease may cause hypertension through multiple pathways involving both glucocorticoid and mineralocorticoid functions.

Cortisol may raise plasma and extracellular fluid volumes, heighten the body's responsiveness to catecholamines, and contribute to elevated blood pressure. It also impacts the renin-angiotensin system by reducing plasma renin and angiotensin II levels while increasing sensitivity to pressor effects.

Cortisol may also inhibit nitric oxide, a vasodilator.

Each of these mechanisms is thought to contribute to the hypertension often seen in Cushing's disease. 

Bone Health Issues

Osteoporosis

High levels of glucocorticoids may lead to secondary osteoporosis through several mechanisms. 

For example, excess glucocorticoids may increase bone resorption while decreasing bone formation. They may also impair calcium absorption in the intestines and increase calcium excretion through urine, which then causes a compensatory rise in parathyroid hormone (PTH) levels. 

Elevated PTH may further stimulate bone resorption, exacerbating bone loss and osteoporosis

Back Pain

Back pain can be a common complaint among those experiencing Cushing's disease. This is primarily due to the influence of the osteoporotic process

Osteoporosis may significantly increase the risk of vertebral fractures. These fractures are common and can cause spinal deformities and imbalance, leading to chronic back pain. When multiple vertebral fractures occur, they can cause a kyphotic deformity, leading to further pain and disability. 

Reproductive and Sexual Health Symptoms

Reproductive and sexual health symptoms are also common amongst this population:

Menstrual Irregularities

In up to 80% of cycling women with Cushing's disease, menstrual irregularities, including oligomenorrhea (irregular periods), amenorrhea (no periods in premenopausal women), and polymenorrhea (more frequent periods), can occur. 

This is due to the complex relationship between cortisol and female and male reproductive hormones. High cortisol levels may impair normal hypothalamic-pituitary-gonadal (HPG) axis function, causing a range of menstrual changes.

It may do this in part by interfering with the secretion of gonadotropin-releasing hormone (GnRH) from the hypothalamus, leading to disruptions in the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are essential for normal ovarian function and menstrual regularity

Erectile Dysfunction

Up to 69% of men with endogenous hypercortisolism, as in Cushing's disease, report decreased libido. This condition may also lead to erectile dysfunction, although the exact prevalence of ED in these patients is not fully known.

Several mechanisms may contribute to this, including:

  • Disruption of the hypothalamic-pituitary-gonadal (HPG) axis, which may reduce testosterone production
  • A direct negative impact of high cortisol on sexual function (cortisol levels typically decline with the initiation of penile erection)
  • Metabolic conditions like diabetes, obesity, and hypertension which can all impact erectile function

Less Common But Noteworthy Symptoms

While these aren't the most common, they are still important to explore and understand:

Increased Thirst and Urination

People with Cushing's disease can present with polyuria (excessive urination) and polydipsia (excessive thirst), contributing to a clinical picture that may be mistaken for diabetes.

These symptoms are typical in Cushing's due to the body's response to prolonged exposure to high cortisol levels, which can disrupt normal fluid balance and increase thirst and urination.

Headaches and Visual Disturbances

Cushing's disease is most often linked to small brain tumors known as pituitary microadenomas (tumors smaller than 10 mm), which typically do not cause headaches or visual disturbances.

While visual disturbances are often expected with larger pituitary adenomas, this finding in Cushing's disease is rare.

However, headaches and visual disturbances may occasionally be seen in Cushing's disease. Because large brain tumors in Cushing's disease are uncommon, intracranial hypertension should be considered as a cause for these symptoms.

Decreased Immunity

Elevated cortisol levels in Cushing's syndrome may cause a profound immune system suppression, impacting all immune cell types. 

This suppression may involve increased cell death, disrupted immune regulation, and weakened responses, making patients more prone to infections, including viral and opportunistic ones. 

Cortisol-induced lymphopenia, or decreased white blood cell counts, may further increase infection susceptibility. This decreased immune function, combined with thinning skin, may also contribute to slower wound healing.

Unusual Fatigue Despite Rest

Cortisol is closely linked with energy metabolism. High cortisol levels have been linked to fatigue.

When to See Your Doctor

Cushing's disease can be mistaken for other conditions. If you're feeling unwell, it's important to consult your doctor for evaluation and management.

Recognizing the Symptoms

Unexplained weight gain, muscle weakness, high blood pressure, or mood changes should not be ignored. These could signal Cushing's Disease or another endocrine or metabolic issue. 

Because these symptoms can be subtle and worsen over time, it's important to seek medical advice if they persist.

Importance of Early Medical Consultation

Early diagnosis is crucial in managing Cushing's disease effectively. Prompt medical consultation can help manage symptom progression and reduce the risk of serious complications.

If your symptoms persist or worsen, don't delay seeking medical help—early intervention can significantly improve your quality of life.

Diagnostic Process

Expect a thorough diagnostic process, including a physical exam, hormone assessments, and possibly imaging studies like CT scans or MRIs. These tests help confirm the diagnosis and guide the management plan.

Who to See

Consult an endocrinologist for diagnosis and management of Cushing's Disease. These specialists are experts in hormone-related disorders and can provide the precise care you need. Early referral to a specialist ensures a more accurate diagnosis and tailored management.

[signup]

Key Takeaways

  • Cushing's disease is a serious but rare hormonal disorder caused by excessive cortisol due to a pituitary adenoma. 
  • Symptoms may include unexplained weight gain, muscle weakness, high blood pressure, mood changes, and skin changes. Early detection for effective management and reducing complications like cardiovascular issues, osteoporosis, and cognitive problems is important.
  • While rare, Cushing's disease is an important condition for medical providers to identify and refer to the proper specialists.
  • If you have persistent symptoms, consult a healthcare provider promptly. Early intervention can lead to quicker diagnosis and management, preventing disease progression and minimizing long-term risks.
  • With timely management, Cushing's disease symptoms can be addressed, significantly improving quality of life. Stay hopeful and proactive in seeking medical advice, as early intervention can lead to successful outcomes.
The information provided is not intended to be a substitute for professional medical advice. Always consult with your doctor or other qualified healthcare provider before taking any dietary supplement or making any changes to your diet or exercise routine.
Learn More
No items found.

Lab Tests in This Article

No lab tests!
  1. Arnaldi, G., & Martino, M. (2019). Androgens in Cushing's Syndrome. Frontiers of hormone research, 53, 77–91. https://doi.org/10.1159/000494904
  2. Barbot, M., Ceccato, F., & Scaroni, C. (2019). The Pathophysiology and Treatment of Hypertension in Patients With Cushing's Syndrome. Frontiers in endocrinology, 10, 321. https://doi.org/10.3389/fendo.2019.00321
  3. Buliman, A., Tataranu, L. G., Paun, D. L., Mirica, A., & Dumitrache, C. (2016). Cushing's disease: a multidisciplinary overview of the clinical features, diagnosis, and treatment. Journal of medicine and life, 9(1), 12–18.
  4. Castinetti, F., Morange, I., Conte-Devolx, B., & Brue, T. (2012). Cushing's disease. Orphanet Journal of Rare Diseases, 7(1), 41. https://doi.org/10.1186/1750-1172-7-41
  5. Chaudhry HS, Singh G. Cushing Syndrome. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470218/
  6. Chen, Y., Li, Y., Chen, X., & Sun, Q. (2013). Neuropsychiatric disorders and cognitive dysfunction in patients with Cushing's disease. Chinese Medical Journal, 126(16), 3156–3160. https://doi.org/10.3760/cma.j.issn.0366-6999.20130944.  Accessed at https://journals.lww.com/cmj/fulltext/2013/08300/neuropsychiatric_disorders_and_cognitive.29.aspx
  7. Cloyd, J. A Root Cause Medicine Protocol For Patients With Osteoporosis: Testing, Therapeutic Diet, and Supportive Supplements. (2023, September 6). Rupa Health. https://www.rupahealth.com/post/a-root-cause-medicine-protocol-for-patients-with-osteoporosis-testing-therapeutic-diet-and-supportive-supplements
  8. Cloyd, J. A Functional Medicine Approach to Addressing Hair Loss in Women. (2023, September 8). Rupa Health. https://www.rupahealth.com/post/a-functional-medicine-approach-to-addressing-hair-loss-in-women 
  9. Cloyd, J. Cortisol and Anxiety: Understanding the Connection. (2024, June 7). Rupa Health. https://www.rupahealth.com/post/cortisol-and-anxiety
  10. Cloyd, J. Cortisol and Weight Gain: Understanding the Connection. (2024, April 15). Rupa Health. https://www.rupahealth.com/post/cortisol-and-weight-gain-understanding-the-connection
  11. Cloyd, J. Integrative Approaches to Supporting Mental Health In Chronic Conditions. (2023, September 25). Rupa Health. https://www.rupahealth.com/post/integrative-approaches-to-supporting-mental-health-in-chronic-conditions 
  12. Cloyd J. The Link Between Erectile Dysfunction and Cardiovascular Disease: Understanding the Connection. Rupa Health. Published February 28, 2024. https://www.rupahealth.com/post/the-link-between-erectile-dysfunction-and-cardiovascular-disease-understanding-the-connection 
  13. Cloyd J. Unlocking the Health Benefits of Nitric Oxide: How This Molecule Supports Cardiovascular Health, Exercise Performance, and More. Rupa Health. Published April 27, 2023. https://www.rupahealth.com/post/nitric-oxide 
  14. Cortisol. (n.d.). Rupa Health. https://www.rupahealth.com/biomarkers/cortisol 
  15. Cox, A. 5 Science Backed Health Benefits of Collagen. (2022, November 3). Rupa Health. https://www.rupahealth.com/post/5-science-backed-health-benefits-of-collagen 
  16. de Guia, R. M., Rose, A. J., & Herzig, S. (2014). Glucocorticoid hormones and energy homeostasis. Hormone molecular biology and clinical investigation, 19(2), 117–128. https://doi.org/10.1515/hmbci-2014-0021
  17. Diorio, B. (2023, January 27). Functional medicine labs that are important for longevity and cognition. Rupa Health. https://www.rupahealth.com/post/functional-medicine-labs-that-are-important-to-longevity-and-cognition
  18. Diorio, B. (2023, March 17). How to test for hypothalamic-pituitary-adrenal (HPA) axis dysfunction. Rupa Health. https://www.rupahealth.com/post/what-is-the-hypothalamic-pituitary-adrenal-hpa-axis 
  19. Fleseriu, M., Auchus, R., Bancos, I., Ben-Shlomo, A., Bertherat, J., Biermasz, N. R., Boguszewski, C. L., Bronstein, M. D., Buchfelder, M., Carmichael, J. D., Casanueva, F. F., Castinetti, F., Chanson, P., Findling, J., Gadelha, M., Geer, E. B., Giustina, A., Grossman, A., Gurnell, M., Ho, K., … Biller, B. M. K. (2021). Consensus on diagnosis and management of Cushing's disease: a guideline update. The lancet. Diabetes & endocrinology, 9(12), 847–875. https://doi.org/10.1016/S2213-8587(21)00235-7
  20. Follicle-Stimulating Hormone. Rupa Health. https://www.rupahealth.com/biomarkers/fsh 
  21. FORGET, H., LACROIX, A., SOMMA, M., & COHEN, H. (2000). Cognitive decline in patients with Cushing's syndrome. Journal of the International Neuropsychological Society, 6(1), 20–29. https://doi.org/10.1017/s1355617700611037
  22. Garrison, K. Cortisol and Stress: Exploring the Connection for Better Health. (2024, April 30). Rupa Health. https://www.rupahealth.com/post/cortisol-and-stress-exploring-the-connection-for-better-health
  23. Garrison, K. How Does Aldosterone Influence Cortisol Levels? Rupa Health. Published July 2, 2024. Accessed August 23, 2024. https://www.rupahealth.com/post/cortisol-and-aldosterone 
  24. Halimova, Z Y & Irgasheva. O B (2021). Turakulov Republican Specialized Scientific and Practical Medical Center of Endocrinology of the Ministry of Health of the Republic of Uzbekistan, Tashkent, Republic of Uzbekistan. INTERNATIONAL JOURNAL of ENDOCRINOLOGY (Ukraine), 16(4), 310–315. https://doi.org/10.22141/2224-0721.16.4.2020.208483
  25. Hasenmajer, V., Sbardella, E., Sciarra, F., Minnetti, M., Isidori, A. M., & Venneri, M. A. (2020). The Immune System in Cushing's Syndrome. Trends in Endocrinology & Metabolism, 31(9), 655–669. https://doi.org/10.1016/j.tem.2020.04.004
  26. Hodgens A, Sharman T. Corticosteroids. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554612/
  27. Irvine, E., Yap, Y. W., Purewal, T., & Irvine, E. (2017). A case of acute confusion: Cushing's syndrome presentingwith primary hyperparathyroidism. BMJ case reports, 2017, bcr2016218694. https://doi.org/10.1136/bcr-2016-218694
  28. Jalal, F. H., & Rajoo, S. (2021). INTRACRANIAL HYPERTENSION: A RARE BUT IMPORTANT CAUSE OF HEADACHE IN A YOUNG FEMALE WITH CUSHING'S DISEASE. Journal of the ASEAN Federation of Endocrine Societies, 37(2021), 44–44. https://doi.org/10.15605/jafes.036.s59
  29. Kairys N, Anastasopoulou C, Schwell A. Cushing Disease. [Updated 2023 Feb 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448184/
  30. Khakham, C. Top Labs To Run Bi-Annually On Your Male Low Libido Patients. (2023, August 4). Rupa Health. https://www.rupahealth.com/post/top-labs-to-run-bi-annually-on-your-male-low-libido-patients
  31. Khakham, C. Top Labs To Run Bi-Annually On Your Patients Experiencing Fatigue. Rupa Health. Published August 2, 2023. https://www.rupahealth.com/post/top-labs-to-run-bi-annually-on-your-patients-experiencing-fatigue
  32. Khakham, C. (2023, August 25). Top Labs To Run Bi-Annually On Your High Blood Pressure Patients. Rupa Health. https://www.rupahealth.com/post/top-labs-to-run-bi-annually-on-your-high-blood-pressure-patients
  33. Khakham, C. (2023, April 6). Understanding Your Risk of Cardiovascular Disease With Functional Medicine Labs. Rupa Health. https://www.rupahealth.com/post/understanding-your-risk-of-cardiovascular-disease-with-functional-medicine-labs 
  34. Lee, I. H., Miller, N. R., Zan, E., Tavares, F., Blitz, A. M., Sung, H., Yousem, D. M., & Boland, M. V. (2015). Visual Defects in Patients With Pituitary Adenomas: The Myth of Bitemporal Hemianopsia. American Journal of Roentgenology, 205(5), W512–W518. https://doi.org/10.2214/ajr.15.14527
  35. Lila, A. R., Sarathi, V., Jagtap, V. S., Bandgar, T., Menon, P., & Shah, N. S. (2011). Cushing's syndrome: Stepwise approach to diagnosis. Indian journal of endocrinology and metabolism, 15 Suppl 4(Suppl4), S317–S321. https://doi.org/10.4103/2230-8210.86974
  36. Lindholm, J., Juul, S., Jørgensen, J. O. L., Astrup, J., Bjerre, P., Feldt-Rasmussen, U., Hagen, C., Jørgensen, J., Kosteljanetz, M., Kristensen, L. Ø., Laurberg, P., Schmidt, K., & Weeke, J. (2001). Incidence and Late Prognosis of Cushing's Syndrome: A Population-Based Study. The Journal of Clinical Endocrinology & Metabolism, 86(1), 117–123. https://doi.org/10.1210/jcem.86.1.7093
  37. Luteinizing Hormone. (n.d.). Rupa Health. https://www.rupahealth.com/biomarkers/lh 
  38. Magerman, R. Cortisol Effects in Depression with Stress Management Tips. Rupa Health. Published June 20, 2024. Accessed August 23, 2024. https://www.rupahealth.com/post/cortisol-and-depression 
  39. McKay LI, Cidlowski JA. Physiologic and Pharmacologic Effects of Corticosteroids. In: Kufe DW, Pollock RE, Weichselbaum RR, et al., editors. Holland-Frei Cancer Medicine. 6th edition. Hamilton (ON): BC Decker; 2003. Available from: https://www.ncbi.nlm.nih.gov/books/NBK13780/
  40. Menconi, M., Fareed, M., O'Neal, P., Poylin, V., Wei, W., & Hasselgren, P. O. (2007). Role of glucocorticoids in the molecular regulation of muscle wasting. Critical care medicine, 35(9 Suppl), S602–S608. https://doi.org/10.1097/01.CCM.0000279194.11328.77
  41. Michaud, K., Forget, H., & Cohen, H. (2009). Chronic glucocorticoid hypersecretion in Cushing's syndrome exacerbates cognitive aging. Brain and Cognition, 71(1), 1–8. https://doi.org/10.1016/j.bandc.2009.02.013
  42. Morgan, S. A., Hassan-Smith, Z. K., & Lavery, G. G. (2016). MECHANISMS IN ENDOCRINOLOGY: Tissue-specific activation of cortisol in Cushing's syndrome. European journal of endocrinology, 175(2), R83–R89. https://doi.org/10.1530/EJE-15-1237
  43. Naz, M. S. G., Dovom, M. R., & Tehrani, F. R. (2020). [PDF] The Menstrual Disturbances in Endocrine Disorders: A Narrative Review | Semantic Scholar. (2019). Semanticscholar.org. https://www.semanticscholar.org/reader/25b7d5b8b6d495d6fd5b1dd39f36d78481e88b53
  44. Nieman L. K. (2015). Cushing's syndrome: update on signs, symptoms and biochemical screening. European journal of endocrinology, 173(4), M33–M38. https://doi.org/10.1530/EJE-15-0464
  45. Nieman, L. K., Biller, B. M., Findling, J. W., Newell-Price, J., Savage, M. O., Stewart, P. M., & Montori, V. M. (2008). The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. The Journal of clinical endocrinology and metabolism, 93(5), 1526–1540. https://doi.org/10.1210/jc.2008-0125
  46. Orbeta R. 10 Type 2 Diabetes Risk Factors You May Not Know About. Rupa Health. Published June 6, 2022. https://www.rupahealth.com/post/what-causes-type-2-diabetes 
  47. Parathyroid Hormone. Rupa Health. https://www.rupahealth.com/biomarkers/pth 
  48. Paravati S, Rosani A, Warrington SJ. Physiology, Catecholamines. [Updated 2022 Oct 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507716/
  49. Powell, D. J., Liossi, C., Moss-Morris, R., & Schlotz, W. (2013). Unstimulated cortisol secretory activity in everyday life and its relationship with fatigue and chronic fatigue syndrome: a systematic review and subset meta-analysis. Psychoneuroendocrinology, 38(11), 2405–2422. https://doi.org/10.1016/j.psyneuen.2013.07.004
  50. Ramírez-Villaescusa, J., Ruiz-Picazo, D., Oliveira, C. L., & Morillas-Ariño, C. (2020). Secondary thoracolumbar deformity and sagittal imbalance due to osteoporosis in a young man with Cushing's disease: A case report.International journal of surgery case reports, 76, 134–138. https://doi.org/10.1016/j.ijscr.2020.09.182
  51. Resmini, E., Santos, A., Gómez-Anson, B., Vives, Y., Pires, P., Crespo, I., Portella, M. J., de Juan-Delago, M., Barahona, M. J., & Webb, S. M. (2012). Verbal and visual memory performance and hippocampal volumes, measured by 3-Tesla magnetic resonance imaging, in patients with Cushing's syndrome. The Journal of clinical endocrinology and metabolism, 97(2), 663–671. https://doi.org/10.1210/jc.2011-2231
  52. Saei Ghare Naz, M., Rostami Dovom, M., & Ramezani Tehrani, F. (2020). The Menstrual Disturbances in Endocrine Disorders: A Narrative Review. International Journal of Endocrinology and Metabolism, 18(4). https://doi.org/10.5812/ijem.106694
  53. Salvio, G., Martino, M., Giancola, G., Arnaldi, G., & Balercia, G. (2021). Hypothalamic–Pituitary Diseases and Erectile Dysfunction. Journal of Clinical Medicine, 10(12), 2551. https://doi.org/10.3390/jcm10122551
  54. Starkman, M. N., Giordani, B., Berent, S., Schork, M. A., & Schteingart, D. E. (2001). Elevated cortisol levels in Cushing's disease are associated with cognitive decrements. Psychosomatic medicine, 63(6), 985–993. https://doi.org/10.1097/00006842-200111000-00018
  55. Steffensen, C., Bak, A. M., Rubeck, K. Z., & Jørgensen, J. O. L. (2010). Epidemiology of Cushing’s syndrome.Neuroendocrinology, 92 Suppl 1, 1–5. https://doi.org/10.1159/000314297
  56. Stratakis C. A. (2016). Skin manifestations of Cushing's syndrome. Reviews in endocrine & metabolic disorders, 17(3), 283–286. https://doi.org/10.1007/s11154-016-9399-3
  57. Sweetnich, J. (2023, March 28). Calcium 101: Testing, top foods, & supplements. Rupa Health. https://www.rupahealth.com/post/calcium-101-testing-top-foods-supplements 
  58. Sweetnich, J. How To Get Rid of Hormonal Acne Naturally. (2023, April 13). Rupa Health. https://www.rupahealth.com/post/how-to-get-rid-of-hormonal-acne-naturally 
  59. Sweetnich, J. (2023, April 4). What is Potassium's Role in The Body? Rupa Health. https://www.rupahealth.com/post/potassium-101 
  60. Sweetnich, J. (2023, March 15). Sodium 101: Lab Tests, Disorders, & How Much To Consume Daily. Rupa Health. https://www.rupahealth.com/post/sodium-101 
  61. Testosterone. (n.d.). Rupa Health. https://www.rupahealth.com/biomarkers/testosterone 
  62. Tomita A. (1998). Nihon rinsho. Japanese journal of clinical medicine, 56(6), 1574–1578.
  63. Trabzonlu, L., Agirlar Trabzonlu, T., Gurbuz, Y., & Ceylan, S. (2020). ACTH-Cell Pituitary Adenoma With Signet Ring Cells: A Rare Case Report and Review of The Literature. Applied immunohistochemistry & molecular morphology : AIMM, 28(2), e13–e16. https://doi.org/10.1097/PAI.0000000000000639
  64. Watson S, Mackin P. HPA axis function in mood disorders. Psychiatry. 2006;5(5):166-170. https://doi.org/10.1383/psyt.2006.5.5.166
  65. Weinberg, J. ACTH Hormone: Roles, Regulation, and Health Implications. (2024, April 5). Rupa Health. https://www.rupahealth.com/post/acth-hormone-roles-regulation-and-health-implications
  66. Weinberg, J. (2023, January 11). How To Test Your Patients For Metabolic Syndrome. Rupa Health. https://www.rupahealth.com/post/how-to-test-your-patients-for-metabolic-syndrome-a-functional-medicie-approach
  67. Weinberg, J. (2024, March 6). What is Cushing's Syndrome?: Testing and Treatments. Rupa Health. https://www.rupahealth.com/post/what-is-cushings-syndrome-testing-and-treatments 
  68. Wirostko B, Christiansen SM. Causes and risk factors. Published online May 1, 2013:18-31. https://www.semanticscholar.org/paper/Causes-and-risk-factors-Wirostko-Christiansen/233d23fc98fad1d33b61263c6d9edda9f1a27104 
  69. Yoshimura, H. Top Labs To Run Bi-Annually On Your Irregular Menstrual Cycle Patients. (2023, August 7). Rupa Health. https://www.rupahealth.com/post/top-labs-to-run-bi-annually-on-your-irregular-menstrual-cycle-patients
  70. Young, A. H. (2004). Cortisol in Mood Disorders. Stress, 7(4), 205–208. https://doi.org/10.1080/10253890500069189
  71. Zilio M, Barbot M, Ceccato F, et al. Diagnosis and complications of Cushing's disease: gender-related differences. Clinical endocrinology. 2014;80(3):403-410. https://doi.org/10.1111/cen.12299
Subscribe to the Magazine for free to keep reading!
Subscribe for free to keep reading, If you are already subscribed, enter your email address to log back in.
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
Are you a healthcare practitioner?
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
See All Magazine Articles
Trusted Source
The Journal of Pediatrics
Peer Reviewed Journal
Visit Source
CDC
Government Authority
Visit Source
Office of Dietary Supplements
Government Authority
Visit Source
National Heart Lung and Blood Institute
Government Authority
Visit Source
National Institutes of Health
Government Authority
Visit Source
Clinical Infectious Diseases
Peer Reviewed Journal
Visit Source
Brain
Peer Reviewed Journal
Visit Source
The Journal of Rheumatology
Peer Reviewed Journal
Visit Source
Journal of the National Cancer Institute (JNCI)
Peer Reviewed Journal
Visit Source
Journal of Cardiovascular Magnetic Resonance
Peer Reviewed Journal
Visit Source
Hepatology
Peer Reviewed Journal
Visit Source
The American Journal of Clinical Nutrition
Peer Reviewed Journal
Visit Source
The Journal of Bone and Joint Surgery
Peer Reviewed Journal
Visit Source
Kidney International
Peer Reviewed Journal
Visit Source
The Journal of Allergy and Clinical Immunology
Peer Reviewed Journal
Visit Source
Annals of Surgery
Peer Reviewed Journal
Visit Source
The Journal of Neurology, Neurosurgery & Psychiatry
Peer Reviewed Journal
Visit Source
Chest
Peer Reviewed Journal
Visit Source
Blood
Peer Reviewed Journal
Visit Source
Gastroenterology
Peer Reviewed Journal
Visit Source
The American Journal of Respiratory and Critical Care Medicine
Peer Reviewed Journal
Visit Source
The American Journal of Psychiatry
Peer Reviewed Journal
Visit Source
Diabetes Care
Peer Reviewed Journal
Visit Source
The Journal of the American College of Cardiology (JACC)
Peer Reviewed Journal
Visit Source
The Journal of Clinical Oncology (JCO)
Peer Reviewed Journal
Visit Source
Journal of Clinical Investigation (JCI)
Peer Reviewed Journal
Visit Source
Circulation
Peer Reviewed Journal
Visit Source
JAMA Internal Medicine
Peer Reviewed Journal
Visit Source
PLOS Medicine
Peer Reviewed Journal
Visit Source
Annals of Internal Medicine
Peer Reviewed Journal
Visit Source
Nature Medicine
Peer Reviewed Journal
Visit Source
The BMJ (British Medical Journal)
Peer Reviewed Journal
Visit Source
The Lancet
Peer Reviewed Journal
Visit Source
Journal of the American Medical Association (JAMA)
Peer Reviewed Journal
Visit Source
Pubmed
Comprehensive biomedical database
Visit Source
Harvard
Educational/Medical Institution
Visit Source
Cleveland Clinic
Educational/Medical Institution
Visit Source
Mayo Clinic
Educational/Medical Institution
Visit Source
The New England Journal of Medicine (NEJM)
Peer Reviewed Journal
Visit Source
Johns Hopkins
Educational/Medical Institution
Visit Source