What it is
Cushing's syndrome happens when the body is exposed to too much cortisol, a stress hormone, over a long period.
The most common cause is long-term use of steroid medicines such as prednisolone or dexamethasone, including creams, inhalers and some unregulated herbal remedies that may contain hidden steroids. Less often, the body makes too much cortisol itself because of a pituitary tumour (Cushing's disease), an adrenal tumour or, rarely, a tumour elsewhere.
Untreated, excess cortisol can lead to diabetes, high blood pressure, weak bones, infections and heart disease, so it needs careful diagnosis and treatment.
Common symptoms
- Weight gain in the face (a rounder, fuller face) and belly, with thinner arms and legs
- A fatty hump between the shoulders
- Wide purple stretch marks on the belly, thighs or arms
- Thin skin that bruises easily, and slow healing
- Muscle weakness, especially in the thighs
- High blood pressure and high blood sugar
- Irregular periods, excess hair growth or low sex drive
- Mood changes, poor sleep and low bone density
When to see a specialist
- You have several of the features above, particularly if they're getting worse
- You have taken steroid medicines, or remedies of unknown content, for a long time
- Your blood pressure, blood sugar or bone density is worse than expected for your age
- A scan found a pituitary or adrenal lump
Don't stop steroid medicines suddenly on your own. Stopping abruptly can be dangerous, so reducing them should be planned with a doctor.
Treatment and management
- Confirming excess cortisol with specialised tests, such as late-night salivary cortisol, 24-hour urine cortisol or a dexamethasone suppression test
- Finding the source with further blood tests and pituitary or adrenal scans
- Treating the cause: carefully reducing steroid medicines when they're responsible, or referral for surgery for a tumour
- Treating the effects, such as diabetes, high blood pressure and bone loss
- Follow-up, including support while the body's own cortisol production recovers
How an endocrinologist helps
Cushing's syndrome can be difficult to diagnose, and the tests must be chosen and interpreted carefully. Dr. Marium Zaman coordinates the diagnostic steps, explains each stage, and manages treatment and recovery together with surgical teams when needed.
