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Cushing Syndrome

Cushing syndrome due to adrenal tumor Endocrine glands Adrenal metastases, CT scan Adrenal Tumor - CT Definition: Cushing syndrome due to adrenal tumor is an endocrine system disorder that occurs when there is a tumor of the adrenal gland releasing excess amounts of the hormone cortisol. Alternative Names: Adrenal tumor - Cushing syndrome Causes, incidence, and risk factors: Cushing syndrome is caused by constant, high levels of the steroid hormone cortisol. A tumor on one of the adrenal glands causes about 15% of all cases of Cushing syndrome. Adrenal tumors release cortisol. Adrenal tumors may be non-cancerous (benign) or cancerous (malignant). Non-cancerous tumors that may cause Cushing syndrome include: Adrenal adenomas Micronodular hyperplasia Cancerous tumors that may cause Cushing syndrome include: Adrenal carcinomas Adrenal tumors are rare. They may develop in anyone at any age, but are much more common in adults. They are found in women more often than men. See also: Cushing's disease Cushing syndrome Ectopic Cushing syndrome Exogenous Cushing syndrome Symptoms: Breast development and impotence in men Depression Headache High blood pressure Round, red, and full face (moon face) Skin changes Acne or other skin infections Easy bruising Purple streaks on the skin of the abdomen, thighs, and breasts Thinning of the skin Stopping of menstruation in women Weight gain Abdomen that sticks out and thin arms and legs Collection of fat between the shoulders (buffalo hump) Weakened bones (osteoporosis) Weakness (often noticed when trying to stand up or to raise hand above head) Patients with a cancerous adrenal tumor may also have symptoms of higher-than-normal male hormone (androgen) levels, including: Acne Excess hair in unusual parts of the body (in women) Scalp hair loss Signs and tests: Tests to confirm Cushing syndrome: 24-hour urine sample to measure the following: Urine cortisol Urine creatinine Dexamethasone suppression test Serum cortisol levels Tests to determine cause: Abdominal CT ACTH High-dose dexamethasone suppression test Other findings may include: High cholesterol High fasting glucose Low bone density, seen by dual x-ray absorptiometry (DEXA) Low serum potassium Treatment: Cushing syndrome due to an adrenal tumor is treated with surgery to remove the tumor and often the entire adrenal gland. Glucocorticoid replacement treatment is usually needed until the other adrenal gland recovers from surgery. You may need this treatment for 9 - 12 months. If surgery is not possible (such as in cases of adrenal cancer), medicines can be used to stop the release of cortisol. These include: Aminoglutethimide Ketoconazole Mifepristone Mitotane Radiation therapy usually does not work for cancerous adrenal tumors and is not appropriate for non-cancerous tumors. Expectations (prognosis): Patients with an adrenal tumor who have surgery have an excellent outlook. Surgery success rates are very high with this type of tumor. For adrenal cancer, surgery is sometimes not possible. When surgery is performed, it does not always cure the cancer. Complications: Cancerous adrenal tumors can spread to the liver or lungs. Calling your health care provider: Call your health care provider if you develop any symptoms of Cushing syndrome. Prevention: Appropriate treatment of adrenal tumors may reduce the risk of complications in some patients with tumor-related Cushing syndrome. References: Stewart PM. The Adrenal Cortex. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR. Kronenberg: Williams Textbook of Endocrinology. 11th ed. Saunders Elsevier; 2008:chap 14.

Review Date:3/18/2008 Reviewed By:Elizabeth H. Holt, MD, PhD, Assistant Professor of Medicine, Section of Endocrinology and Metabolism, Yale University. Review provided by VeriMed Healthcare Network. Also reviewed byDavid Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.