National Endocrine and Metabolic Diseases Information Service US Department Human Services NATIONAL INSTITUTES hormone cortisol Sometimes called adults aged 20 to 50 People who are obese What are the ID: 896800
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1 Cushing’s Syndrome National Endocrine
Cushing’s Syndrome National Endocrine and Metabolic Diseases Information Service U.S. Department Human Services NATIONAL INSTITUTES hormone cortisol. Sometimes called adults aged 20 to 50. People who are obese What are the signs and symptoms of Cushing’s increased fat around the neck, and relatively slender arms and legs. Children tend to be and heals poorly. Purple or pink stretch Women with Cushing’s syndrome usually chest, abdomen, and thighs. Their menstrual cortisol for too long. Many people develop in ammatory diseases. Glucocorticoids are cortisol. Normally, the production of to the pituitary gland. CRH causes the hormone (ACTH), which stimulates the the ACTH, they respond by releasing cortisol cardiova
2 scular function in ammatory res
scular function in ammatory response breaks down glucose for energy carbohydrates, and fats Pituitary gland Hypothalamus CRH ACTH Cortisol Adrenal glands responds by secreting ACTH. ACTH then causes the to help the body respond to stress. For People suffering from depression, release less CRH and ACTH. This process meet the body’s daily needs. However, if Pituitary Adenomas Pituitary adenomas cause 70 percent of caused by glucocorticoid use. These benign, gland secrete extra ACTH. Most people Ectopic ACTH Syndrome produce ACTH. This condition is known as ectopic ACTH syndrome. Lung tumors women. The most common forms of ACTH- 2 of the body. Other less common types of tumors that can produce ACT
3 H are 1 Nieman LK, Ilias I. Evaluation
H are 1 Nieman LK, Ilias I. Evaluation and treatment . 2005;118(12):1340–1346. Govindan R, Page N, Morgensztern D, et al. Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the . 2006;24:4539–4544. Cushing’s syndrome. Adrenal tumors are is about 40. Most of these cases involve Adrenocortical carcinomas—adrenal Cushing’s syndrome. Wa type of male hormone. Adrenocortical Familial Cushing’s Syndrome inherited. Rarely, however, Cushing’s glands. Endocrine glands release hormones into the bloodstream. With primary glands. With multiple endocrine neoplasia amilial Cushing’s Syndrome amilial Cushing’s Syndrome 3 Cushing’s Syndrome How is Cush
4 ing’s and laboratory tests. X rays of
ing’s and laboratory tests. X rays of the adrenal Tests to Diagnose several are needed. The three most common dexamethasone suppression test. Another and tested for cortisol. Levels higher blood. Cortisol production is normally occur. If the cortisol level is more test. A modi ed LDDST uses a oneCortisol and other glucocorticoids signal the pituitary to release less ACTH, Cushing’s syndrome. On the other the skin. These people may have pseudo-Cushing’s syndrome, a condition Pseudo-Cushing’s does not have the from mild cases of Cushing’s. This CRH stimulation test. In the CRH Pretreatment with dexamethasone Cushing’s. Elevations of cortisol during Tests to Find the Cause to excess cortisol product
5 ion. The choice of with ectopic ACTH syn
ion. The choice of with ectopic ACTH syndrome or adrenal tumors. As a result of the pituitary. This response is rarely seen in people with ectopic ACTH syndrome same as the LDDST, except it uses ACTH-producing tumors. High doses ACTH-producing tumors. he Cause he Cause 5 Cushing’s Syndrome (MRI). A CT scan produces a series of image of a body part. MRI also made. Imaging is not used to make glands. These tumors, sometimes harmful. They are not removed unless Petrosal sinus sampling. syndrome. Samples of blood are drawn ACTH, is given during this test to evels of ACTH in the petrosal sinuses ACTH levels in a forearm vein. Higher Similar levels of ACTH in suggest ectopic ACTH syndrome. How is Cushing’s syndrome treated? T
6 reatment depends on the speci c reas
reatment depends on the speci c reason cortisol-inhibiting drugs. If the cause is effects. In some cases, noncorticosteroid Pituitary Adenomas ACTH-secreting pituitary adenomas of Cushing’s disease. The most widely used opening made below the upper lip. Because this type of surgery. The success, or with extensive experience. If surgery fails or production of ACTH drops two levels below normal. This drop is natural and temporary, to compensate. Most people can stop this treatment. Rtreatment alone. Combining radiation and metyrapone. Each drug has its own Ectopic ACTH Syndrome To cure the overproduction of cortisol caused by ectopic ACTH syndrome, all ACTH must be eliminated. The choice spread. Because ACTH-secreting tumo
7 rs are an important part of treatment. I
rs are an important part of treatment. In glands. Primary pigmented micronodular CTH Syndrome CTH Syndrome 7 Cushing’s Syndrome Points to Remember N߬‰u?Ëĉ~™ÄË?™aËÄß”¬Í”ÄËwËNÁj?Í”j™ÍËaj¬j™aÄË™Ë͆jËĬju‰xuËHope through Research and the National Center for Research Resources. endocrine system. RTo re ne the diagnostic process, studies are ectopic ACTH syndrome. Researchers are sampling. Research into treatment options by ectopic ACTH secretion. cases of Cushing’s syndrome. In a few a role. Increasing evidence suggests that 8 Cushing’s Syndrome throughout the United
8 States. Scientists in Bethesda, MD. Phys
States. Scientists in Bethesda, MD. Physicians who are may contact Lynnette Nieman, M.D., at NICHD, 10 Center Drive, Room 1–3140, at 301–496–8935. Physicians interested in NICHD, 10 Center Drive, Room 1–3330, For More Information abeur M, Arzt E, Stalla GK, Páez-Pereda M. Current Drug Targets— Newell-Price J, Bertagna X, Grossman A, Nieman L. Cushing’s syndrome. Nieman L, Ilias I. Evaluation and treatment American Association of Rolling Meadows, IL 60008 1–888–566–AANS (2267) Internet: www.NeurosurgeryToday.org To locate a board-certi ed neurosurgeon: www.neurosurgerytoday.org/ ndaneuro Cushing’s Support and Research Foundation, Inc. Boston, MA 02110 Email: cus
9 hinfo@csrf.net Internet: www.CSRF.net P
hinfo@csrf.net Internet: www.CSRF.net Pituitary Network Association P.O. Thousand Oaks, CA 91358 Fax: 805–480–0633 Email: PNA@pituitary.org Internet: www.pituitary.org 9 Cushing’s Syndrome You may also nd additional information about this www.medlineplus.gov This publication may contain information about medications used to treat a health condition. When this publication was prepared, the NIDDK included ally, new information about medication is released. For updates or for questions about any medications, please contact the U.S. Food and Drug Administration at 1–888–INFO–FDA (463–6332), a toll-free call, www.fda.gov. Consult your The U.S. Government does not endorse or favor any speci
10 c commercial product or company. T
c commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not National Endocrine Information Service 6 Information WayFax: 703–738–4929U.S. Department of Health and Human Services. research. As a public service, the NIDDK has established information services to increase disease among patients, health care professionals, Eunice Kennedy house encourages users of this fact sheet to duplicate This fact sheet is also available at www.endocrine.niddk.nih.gov U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES NIH Publication No. 08–3