What is cushing's syndrome?

Cushing's syndrome is a rare problem that happens when you have too much of the hormone cortisol in your body. Cortisol is especially important in controlling blood pressure and metabolism. But it affects almost every area of your body.

Normally, your body keeps the level of cortisol in balance through a complex system that involves three glands.

1. When your cortisol level gets low, a part of the brain called the hypothalamus releases a hormone called CRH.
2. CRH tells the pituitary gland, located beneath the brain, to make a hormone called ACTH.
3. ACTH triggers the adrenal glands, which sit above the kidneys, to release cortisol.

If something upsets this system, your cortisol level can get too high. If it's high for too long, it can cause symptoms and can lead to serious problems, such as diabetes, high blood pressure, depression, and osteoporosis.

Another name for Cushing's syndrome is hypercortisolism.

The symptoms of Cushing's syndrome vary and often appear slowly over time. You may have:

• Weight gain, especially around the waist. This is the most common symptom. You might also have a round face or extra fat around the neck and upper part of the back (buffalo hump).
• Skin changes, such as bruising, acne, or dark purple-red stretch marks on your belly.
• Mood changes, such as feeling irritable, anxious, or depressed.
• Muscle and bone weakness. This may cause backaches, broken bones (especially the ribs and spine), or loss of muscle tone and strength.
• Changes in sex hormone levels. In women, this may cause irregular periods and growth of facial hair. In men, it may cause erection problems or changes in sex drive.

Cushing's syndrome can also lead to other health problems, such as high blood pressure, type 2 diabetes, glaucoma, and cataracts.

A doctor who specializes in hormone disorders (endocrinologist) can help diagnose or treat Cushing's syndrome. To find out if you have it, the doctor will ask questions about your symptoms and check your blood pressure, weight, and skin. Cortisol levels will be checked in your blood, saliva, or urine.

A doctor can usually find out from these tests if steroid medicine is causing the problem. If you don't take steroid medicine or your doctor thinks that something else is causing your symptoms, you may have other tests. These include more tests to check your cortisol and other hormone levels. You may need a CT scan or an MRI to look for a tumor.

If long-term use of steroid medicine is the cause of Cushing's syndrome, your doctor may be able to help you lower your dose gradually. Your doctor might even talk with you about stopping it. Don't try to stop taking the medicine by yourself. That can be dangerous.

If a tumor is the cause, surgery could be an option for some people. Your doctor may also talk with you about other treatment options like medicines or radiation.

• Eat a healthy diet that is high in protein and calcium. This can help prevent muscle and bone loss caused by the high cortisol levels in your body. Talk to your doctor about whether you should take a calcium and vitamin D supplement for bone health.
• Limit salt (sodium) in your diet. This is very important if you have high blood pressure because of Cushing's syndrome.
• Get exercise. Walking is a good choice to start with. Talk with your doctor about how much exercise is safe for you.
• Get regular eye exams to check for glaucoma and cataracts.
• See your doctor regularly to help diagnose and treat diabetes, high blood pressure, and other possible complications.