Cushing’s syndrome is a group of bodily changes caused by an excess of steroid hormones. Most cases are caused by necessary medical treatment, often required to save life. But the condition can also occur as a natural disease affecting the glands that produce steroid hormones. Or it can occur from a disorder of the pituitary gland that prompts these glands to overproduce.

Steroid hormones are produced by the adrenal glands, which sit on top of the kidneys. The hormone from the pituitary gland that prompts the adrenals to produce steroids is called adrenocorticotropic hormone (ACTH).

Medically caused (iatrogenic) Cushing’s syndrome is one of the prices that has to be paid for the benefits, or life-saving effect, of steroids. Doctors will always use steroids at the smallest possible dosage to produce the needed effect.

Causes

Cushing’s syndrome may result from:

• The use of steroid hormones at high and prolonged dosage for medical purposes.
• A tumour of the outer layer (cortex) of an adrenal gland, with overproduction of cortex steroids.
• A pituitary tumour with excess production of ACTH.
• Other tumours which produce ACTH, such as certain forms of cancer of the lung

Treatment

The treatment is directed at the cause; this may involve removing a pituitary tumour or the use of supervoltage radiation to the pituitary gland.

Adrenal tumours are removed surgically. In some cases it may be necessary to remove both adrenal glands, and the person will then have to take replacement hormones.

ACTH-secreting tumours are removed, if possible, but may have to be dealt with by drugs which work against adrenal hormones

Symptoms

People with Cushing’s syndrome are overweight, with fat deposits on the back of the neck and shoulders (‘buffalo hump’) as well as around the middle. The arms and legs are usually slender. The skin is thin and wasted (atrophied) and wounds heal badly. There are often purplish streaks (striae) on the abdomen. The face is red and ‘moon-shaped’ and there is often male-pattern hairiness, or sometimes baldness, in women. There is weakness from wasted muscles, high blood pressure, osteoporosis and often mental disturbances.