Cortisol/Cushing's Syndrome

Q: What is Cushing’s syndrome?

• Cushing’s syndrome is the term used when there is an abnormal, very high level of cortisol in the blood.
• Cushing’s disease refers to tumors of the pituitary gland (in your brain) and comprises about 70 to80 percent of patients
• Cushing’s syndrome can be caused by an adrenal tumor (10 percent), ectopic tumor (most commonly in the lung) (10 percent), or from ingesting excessive amounts of steroids.

Q: What are the signs and symptoms?

• Signs: high blood pressure, diabetes, moon faces (round facial shape), buffalo hump (mound of fat at the back of the neck), stretch marks, abnormal hair growth
• Symptoms: easy bruising, fatigue, weight gain (particularly around the mid-section), leg swelling, mood swings, irregular periods, muscle weakness
• You can have a tumor which produces smaller amounts of cortisol so as not to cause any obvious, overt symptoms.

Q: How is it diagnosed?

• Diagnosis is made by a series of blood tests and imaging. There is no role for needle biopsy, and it is contraindicated.

Q: What is the treatment?

• Treatment depends on the source of the cortisol production.
• For unilateral tumors of the adrenal gland, treatment is laparoscopic removal of the inciting adrenal gland.

Q: Will I be off all my high blood pressure medication after the surgery? Will my diabetes get better? Will I go back to looking like I did a few years ago?

• It may take one to two years, but most patients return to the medical and physical state that existed before they had the tumor. If your diabetes and high blood pressure were new and directly related to the tumor then they will most likely get better. Same as your physical appearance. However, your body needs time to reregulate itself so these changes are not going to happen overnight.

Q: Will I need to take medication after surgery?

• You will need to be on steroids after your surgery for six to 18 months. Your endocrinologist will slowly wean you off from the steroid medication.

Q: Do I need regular follow-up visits?

• Yes. You will return for your post-op visit one to two weeks after surgery and should follow-up with your surgeon during the first two years after surgery.
• You will have more regular follow-up with your endocrinologist to help manage your medications and monitor your blood tests.