Cushing’s disease occurs in response to sustained high cortisol levels. Non-cancerous tumors in the brain’s pituitary gland, called adenomas, trigger an excessive release of adrenocorticotropic hormone (ACTH), which signals the adrenal glands that sit atop the kidneys to produce large amounts of cortisol.
Popularly known as the “stress hormone” because of its heightened release in response to stress, cortisol is involved in multiple body processes. These include regulating salt and sugar levels, blood pressure, inflammation, and respiration, as well as converting food into energy, and even in forming memories.
Chronically high cortisol levels, a condition also known as hypercortisolism, leads to a wide variety of physical, hormonal, and psychological symptoms, some more common than others, and some more specific to men and to women.
Some symptoms, besides excessive cortisol levels, occur frequently in Cushing’s disease and can be considered characteristic of the disorder. They do not always occur together, however, complicating diagnosis. Doctors typically need to perform several tests to rule out other conditions.
The most common symptoms of Cushing’s disease and other forms of Cushing’s syndrome include weight gain, fat accumulation, and skin problems.
Weight gain and fat accumulation
Excessive weight gain and fat accumulation around the torso (central obesity), above the collarbone (supraclavicular fat pad), around the face (“moon face”), or between the shoulders (“buffalo hump”) are common signs of Cushing’s.
Patients with Cushing’s tend to have thinner, fragile skin that bruises easily. They are also more prone to develop acne, skin infections, and to have pink or purple stretch marks (striae) on the abdomen, thighs, breasts, arms, and underarms.
Less common symptoms can arise as Cushing’s disease progresses. These may go unnoticed and untreated for some time, due to the disorder’s gradual progression. People with more advanced Cushing’s may also develop comorbidities, or separate but co-occurring medical conditions.
Some of these may include high blood pressure (hypertension), high cholesterol, high blood sugar levels (associated with diabetes), headaches, feet and/or leg swelling, slow and incomplete wound healing, sleep apnea, and fatigue. Changes in mental health, including depression and anxiety, cognitive difficulties, and poor emotional control are also reported.
Bone, joint, and muscle weakness may also occur in some patients, as well as muscle wasting and bone loss. Over time, this can cause patients to develop osteoporosis — a disease that causes bones to become weaker and brittle — making them more prone to fractures.
Symptoms by demographic group
In its role as a hormone, cortisol can affect people differently based on their age and gender. For instance, in children and adolescents, hypercortisolism can delay growth and physical development. This can also be accompanied by unusual weight gain.
In women, elevated cortisol levels may cause menstrual cycles to become irregular or to cease altogether. High levels of the hormone may also cause women to develop hirsutism, or excessive hair growth, on the face, neck, chest, abdomen, and thighs, or other parts of the body.
In men, unusually high cortisol levels can affect their fertility and sex drive, and cause erectile dysfunction.
Last updated: May 21, 2021
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