Cushing Syndrome Symptoms: Weight Gain, Bruising, High Blood Pressure and Testing

What it involves

MedlinePlus explains that Cushing syndrome is a hormonal disorder that happens when the body has too much of the hormone cortisol over a long period of time. Cortisol is made by the adrenal glands, two small glands that sit above the kidneys, and it helps the body respond to stress, reduce inflammation, control blood sugar and blood pressure, and manage metabolism.

Who this is for

• Adults with weight gain around the belly and upper body, a rounder face and thin arms and legs.
• Patients who take prednisone or another steroid medicine for a long time and notice these changes.
• People with high blood pressure or high blood sugar that is hard to control, plus easy bruising or purple stretch marks.
• Women with new facial hair or irregular periods along with weight gain and fatigue.

What to expect

• Questions about every medicine you use, including pills, shots, inhalers and creams that contain steroids
• An exam with blood pressure, weight, skin and muscle strength checks
• Blood work, which the practice offers, including blood sugar and routine chemistry
• A referral to an endocrinologist for cortisol testing and imaging when the picture fits

What it can look and feel like

The changes tend to build slowly, which is why many people attribute them to age. MedlinePlus describes weight gain mostly around the belly and upper body with thin arms and legs, a rounded face, and extra fat at the base of the neck or a fatty hump between the shoulders. Wide purple stretch marks on the abdomen, breasts, hips and underarms are typical. Men may notice less interest in sex or erectile dysfunction, and children often gain weight while growing more slowly. Other causes of gaining weight are in the unexplained weight gain guide.

Medicine is the most common cause

MedlinePlus says the most common cause is taking high doses of glucocorticoids, a type of steroid medicine such as prednisone, for a long time. These medicines are used to treat conditions such as asthma, rheumatoid arthritis and lupus, and to keep the body from rejecting a transplanted organ. Because of this, a provider will ask about pills, shots, inhalers and creams. Never stop or change the dose of a steroid on your own, since your body may need it. Stopping suddenly can cause a different problem, described in the adrenal insufficiency guide.

Tumor-related causes

Less often a tumor causes the body to make too much cortisol. This type is rare and is most common in adults ages 30 to 50, and it affects about three times as many women as men, according to MedlinePlus. A pituitary tumor that makes too much ACTH is called Cushing disease and is the most common cause when medicine is not to blame. Some tumors outside the pituitary, most often in the lungs, can also make ACTH, and a tumor on an adrenal gland can make cortisol on its own.

How it is diagnosed

MedlinePlus says Cushing syndrome can be hard to diagnose because many symptoms look like other conditions. Your provider asks about your health history and any glucocorticoid use, does a physical exam, and orders tests of cortisol levels in urine, saliva or blood, usually at least two of them: a 24-hour urine test, a late-night saliva test and a dexamethasone suppression test. More tests, such as an ACTH blood test and an MRI or CT scan, can look for the cause. These cortisol and imaging tests are arranged by referral. Routine blood sugar work is covered in the high blood sugar guide.

The problems it can bring

Many of its features are conditions people already manage, which can hide the cause. High blood pressure is explained in the hypertension management page, easy bruising in the easy bruising guide, and the cluster of weight, sugar and pressure changes in the metabolic syndrome guide. Weak bones are covered in the bone density screening guide. MedlinePlus warns that without treatment Cushing syndrome can lead to heart attack, stroke, blood clots, weak bones that break easily and type 2 diabetes.

Treatment and when to be seen

Treatment depends on the cause, and the goal is to return cortisol to normal. If a steroid medicine is responsible, a provider may slowly lower the dose or switch medicines. If a tumor is the cause, MedlinePlus says surgery is probable, with radiation, chemotherapy or cortisol-lowering medicines as other options. Most people get better, though recovery can take time. Call 911 or go to the ER for chest pain, stroke signs such as face drooping or arm weakness, or a swollen painful leg with sudden shortness of breath.

Sources

• MedlinePlus: Cushing Syndrome