What Is Cushing Syndrome? Causes, Symptoms, And Mental Health Effects
Cushing syndrome is a hormonal disorder that occurs when the body produces too much cortisol over an extended period. The hormone cortisol, also known as the stress hormone, plays a key role in the body’s healthy response to stress. However, when cortisol levels become excessively high, it can lead to a wide range of health challenges, potentially affecting physical appearance, mood, and overall well-being. Here, we’ll explore what Cushing syndrome is, key symptoms and treatment options, and how it may affect mental health.
What is Cushing Syndrome?
Cushing syndrome is a hormonal disorder that can develop when the body is exposed to high levels of cortisol for an extended period. Cortisol is a steroid hormone produced by the adrenal glands, which are located on top of the kidneys. It plays a vital role in regulating metabolism, reducing inflammation, maintaining blood pressure, and helping the body respond to stress. However, when cortisol levels become excessive, they can disrupt normal bodily functions and lead to a range of health challenges.
There are two primary types of Cushing syndrome: endogenous Cushing syndrome, which is caused by internal factors, and exogenous Cushing syndrome, caused by external factors. Endogenous Cushing syndrome occurs when the body overproduces cortisol, often due to an adrenal tumor or pituitary tumor. Exogenous Cushing syndrome, on the other hand, may be caused by long-term use of corticosteroid medications, which may be prescribed for inflammatory diseases like asthma and rheumatoid arthritis.
The link between cortisol and the adrenal glands
The adrenal glands play a crucial role in regulating cortisol levels in the body. These small, triangular-shaped glands sit on top of each kidney and are responsible for producing several important hormones, including cortisol. The production of cortisol is controlled by a complex feedback system involving the hypothalamus, pituitary gland, and adrenal glands.
Cortisol production begins when the hypothalamus, a region in the brain, detects that the body needs more cortisol and releases corticotropin-releasing hormone (CRH). The elevated levels of CRH cause the pituitary gland, located at the base of the brain, to release adrenocorticotropic hormone (ACTH) into the bloodstream. The ACTH then signals the adrenal glands to release cortisol. Once enough cortisol is produced, feedback is sent to the hypothalamus and pituitary gland to reduce CRH and ACTH production and maintain balance.
Cortisol affects nearly every organ system in the body. It helps regulate:
- Metabolism: increases blood sugar levels by breaking down fats, proteins, and carbohydrates for energy
- Inflammation: suppresses the immune system when needed to reduce inflammation
- Blood pressure: helps maintain normal blood pressure
- The stress response: prepares the body for "fight-or-flight" situations
Causes of Cushing syndrome
The causes of Cushing syndrome can be divided into two categories depending on whether they’re endogenous (caused by internal factors) or exogenous (caused by external factors). Endogenous Cushing syndrome occurs when the body itself produces excessive cortisol, which is often due to issues with the adrenal or pituitary glands. The most common internal causes include:
- Pituitary tumors (Cushing disease): The most frequent cause of endogenous Cushing syndrome is pituitary adenomas. A pituitary adenoma is a benign pituitary or ectopic tumor that may cause the body to produce too much ACTH, overstimulating the adrenal glands and leading to excessive cortisol production. This specific form of Cushing syndrome is called Cushing disease, accounting for the majority of endogenous cases.
- Adrenal gland tumors: Benign or malignant tumors in the adrenal glands can cause direct overproduction of cortisol. Noncancerous adrenal adenomas are more common, while cancerous adrenocortical carcinomas are rare but more severe.
- Ectopic ACTH-producing tumors: In rare cases, tumors outside the pituitary gland can produce ACTH, leading to excessive cortisol production. This condition is referred to as ectopic ACTH syndrome. Such tumors are often found in the lungs, pancreas, or thymus and are sometimes associated with small-cell lung cancer.
On the other hand, the most common cause of exogenous Cushing syndrome is long-term use of corticosteroid medications, which may be used to treat asthma, arthritis, and certain digestive and kidney diseases. These medications mimic the effects of cortisol, and long-term use can suppress the body’s natural ability to regulate cortisol, potentially leading to Cushing syndrome.
High blood pressure, weight gain, stretch marks, and other physical symptoms
A person living with Cushing syndrome may experience a number of physical symptoms. These may vary from person to person in severity and type. Some common physical symptoms are explored below.
Cushing syndrome and high blood pressure
The excess production of cortisol in individuals with Cushing syndrome may cause high blood pressure, or hypertension. This is because cortisol may enhance the effects of adrenaline and noradrenaline, which are hormones that constrict blood vessels. This may cause increased vasoconstriction, leading to elevated blood pressure and a higher heart rate. Additionally, cortisol may impact the kidneys, causing sodium and water retention—which may cause high blood pressure in turn.
Weight gain
Individuals with Cushing syndrome may experience weight gain as a result of the disorder. Unlike typical weight gain, the fat accumulation in Cushing syndrome often follows a distinct pattern, primarily affecting the face, abdomen, and upper back. This abnormal fat distribution is caused by excessive levels of cortisol, the body's stress hormone, which alters metabolism and fat storage.
Stretch marks
One of the main symptoms of Cushing syndrome is the presence of large purple stretch marks or striations on the skin. These may primarily occur on the abdomen, thighs, breasts, and arms. Stretch marks caused by Cushing syndrome are different from regular stretch marks in both appearance and cause, which makes them a key diagnostic feature of the condition. In someone with Cushing syndrome, excess cortisol breaks down collagen and elastin, the proteins that keep skin strong and elastic. This factor, especially combined with rapid weight gain, may cause this type of stretch marks.
Other symptoms
In addition to weight gain, high blood pressure, and stretch marks, Cushing syndrome can cause a variety of other symptoms that affect multiple body systems. These symptoms typically result from prolonged exposure to high cortisol levels. Some examples these include:
- Skin and hair changes
- Muscle and bone issues
- Reproductive and hormonal effects
- Immune system suppression
- High blood sugar and metabolic changes
Mental health symptoms of Cushing syndrome
Cushing syndrome can affect mental health as well. Some of the most common mental health-related effects of Cushing syndrome include depression and mood swings.
What is the Cushing syndrome link to depression symptoms?
Depression related to Cushing syndrome is common. The production of excess cortisol can impact mood and emotions and may change the chemistry of the brain. High cortisol levels may also alter the balance of neurotransmitters like serotonin, dopamine, and norepinephrine, which regulate mood and emotions. Additional impacts such as sleep disturbances and fatigue due to stress may exacerbate symptoms of depression in individuals with Cushing syndrome.
Mood swings
Individuals living with Cushing syndrome may experience mood swings related to the increase in cortisol. Elevated cortisol can leave the body in a constant state of stress, which may cause irritability and emotional sensitivity. In some cases, this effect may result in anger, anxiety, or feelings of sadness.
Treatment options
If you're experiencing potential symptoms of a serious illness like Cushing disease, it can be important to seek medical evaluation right away. Remember that only a qualified medical professional can diagnose Cushing syndrome. After a diagnosis, there may be a variety of ways to manage the symptoms of Cushing syndrome and to address the underlying causes. Some common treatment options include medication to manage cortisol and/or surgical removal of tumors from the pituitary or adrenal glands.
Medication to manage cortisol
In some cases, a doctor may prescribe medications that inhibit or limit the production of cortisol to lower cortisol levels in the body. Side effects can include nausea and headaches, among others. Another medication type that may be used to manage cortisol levels is a blocker that inhibits the binding of cortisol to receptors in the body.
In cases of exogenous Cushing syndrome, doctors may work with patients to reduce the impact of medications for asthma and arthritis. This approach could include a change in the dosage or type of medicine used.
Removal of tumors from pituitary and adrenal glands
When Cushing syndrome is caused by tumors from the pituitary or adrenal glands, the treatment may involve removing them surgically. The procedure, called transsphenoidal surgery, is performed by a neurosurgeon and aims to restore normal cortisol levels by eliminating the source of excess ACTH production. Cortisol levels may drop rapidly after surgery, so stabilizing is often part of recovery.
How a therapist can help you cope with emotional effects of Cushing syndrome
For individuals living with an illness like Cushing syndrome, mental health challenges such as high stress levels, anxiety, and depression are common. Connecting with a mental health professional like a therapist can give you a space to openly share your emotions about your experience, build healthy coping mechanisms for stress, and receive treatment for any diagnosable mental health conditions you may be experiencing.
While therapy can be a useful tool for mental health, not everyone can regularly attend in-person appointments—including someone who may be experiencing a physical illness like Cushing disease. In such cases, online therapy can represent a way to receive care that may be more convenient. You can attend online therapy sessions from anywhere you have an internet connection and at times that work for you. You can also switch providers at any time for no additional cost, which may help you find the right fit. Research suggests that, like in-person treatment, online talk therapy may be effective at reducing symptoms of depression and anxiety.
Takeaway
Cushing syndrome is a complex disorder that causes elevated levels of cortisol in the body. High levels of cortisol can negatively impact mental and physical health and can be linked to weight gain, high blood pressure, and depression. Treating Cushing syndrome may include removing tumors on the pituitary and adrenal glands and/or medication management options. Connecting with a therapist can be an effective way to manage mental health symptoms associated with Cushing syndrome.
Can you fully recover from Cushing syndrome?
It’s possible to fully recover from Cushing syndrome, but it’s usually a long process. Treatment depends on the cause and clinical manifestations of the condition. Surgery done by neurological surgeons is usually necessary for individuals with pituitary tumors. Sometimes, radiation therapy is also used to treat Cushing syndrome. Clinical trials for novel treatments are ongoing.
What is the life expectancy of a person with Cushing disease?
Although Cushing disease can be fatal when left untreated, it’s often curable with the proper medical treatment. Some research suggests that individuals who are in remission from Cushing disease have a similar life expectancy to people without Cushing disease. Other studies suggest that they have an elevated mortality rate.
How do you feel when your cortisol is high?
High cortisol can lead to symptoms like headaches, irritability, fatigue, weight gain, increased blood pressure, muscle tension, poor sleep, and more. Often, engaging in healthy habits like eating nutritious foods, getting quality sleep each night, and exercising regularly can control cortisol levels.
What is the number-one cause of death in Cushing syndrome?
Cardiovascular disease is the number-one cause of death in Cushing syndrome. Early diagnosis and prompt treatment can reduce the risk of poor outcomes.
What organ does Cushing syndrome affect?
Cushing syndrome often begins with the pituitary gland. As it advances, it can affect other organs as well, particularly the adrenal glands. People with Cushing syndrome tend to have a higher risk of developing blood clots, and they frequently experience muscle weakness, among other symptoms.
How do you flush cortisol out of your body?
Nutritious eating habits, regular exercise, sufficient sleep, relaxation techniques, and limited caffeine intake may eliminate extra cortisol. A few relaxation strategies to try include deep breathing, meditation, yoga, and creative hobbies.
Can you be skinny with Cushing syndrome?
Most people with Cushing syndrome are overweight, as weight gain is seen in most cases. However, a small minority of individuals with Cushing syndrome may lose weight.
What is the difference between Cushing syndrome and Cushing disease?
Cushing disease is categorized as a specific type of Cushing syndrome. Cushing syndrome has two types: exogenous (caused by external factors) and endogenous (caused by internal factors). Both types have the same symptoms. Cushing disease is the most common endogenous type of Cushing syndrome, typically caused by a tumor on the pituitary gland.
What can be mistaken for Cushing syndrome?
Polycystic ovarian syndrome (PCOS) and metabolic syndrome can be mistaken for Cushing syndrome because of their similar symptoms. For example, both Cushing syndrome and PCOS can lead to excessive facial hair. Thorough testing can lead to an accurate diagnosis.
The diagnostic process often includes blood tests to measure ACTH levels and pituitary hormones, urine tests, magnetic resonance imaging tests, and a test in which a person takes glucocorticoid medicines before a blood sample is taken. This test measures whether cortisol levels drop after taking the medication. If they don’t, it can be a sign of Cushing syndrome.
What is the main visible symptom of Cushing syndrome?
There are several visible symptoms that can indicate Cushing syndrome. These include a fatty deposit on the upper back or neck area, weight gain around the abdomen, facial roundness, thin arms and legs, stretch marks, and easy bruising. If you notice these symptoms, getting a blood test to check hormone levels may indicate whether certain hormones (particularly cortisol) are elevated.
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