Endocrinology Essay

Young Sabrina

MGE VI, Group 2

2023

Cushing Syndrome

Cushing syndrome is an endocrine disorder caused by an excess of cortisol, or

hypercortisolism. This is most commonly due to exogenous glucocorticoid administration,

otherwise called iatrogenic Cushing syndrome. It

can also be caused by an endogenous

overproduction of cortisol. There are two types

of Cushing syndrome that can occur: primary

and secondary. Primary Cushing syndrome is

caused by an autonomous overproduction of

cortisol by the adrenal gland, which can be due

to something like an adrenal adenoma or

carcinoma. Secondary Cushing syndrome is

determined by elevated adrenocorticotropic

hormone, or ACTH, due to overproduction by either a pituitary adenoma or ectopic,

paraneoplastic foci. If it is caused by a pituitary adenoma, it is called Cushing Disease.

Normally, the hypothalamus secretes corticotropin-releasing hormone, which

stimulates the pituitary gland to secrete adrenocorticotropic hormone. ACTH then travels to

the adrenal glands, where it targets cells in the adrenal cortex. In the adrenal cortex, ACTH

specifically targets the zona fasciculata to secrete cortisol. Cortisol is a lipid soluble hormone

known as glucocorticoid. Any excess free cortisol is normally filtered in the kidneys and
 disposed of in the urine. Normal cortisol

levels peak in the morning and drop at night.

In times of stress, cortisol is also released to

increase energy, by which it does three

things: increase gluconeogenesis, proteolysis

and lipolysis. It also maintains blood

pressure and dampens the inflammatory and immune response. To maintain normal levels of

cortisol and keep everything functioning normally, the body has a negative feedback loop for

the hormone. In Cushing syndrome, these levels will always be elevated by the causes

mentioned above.

The main features of Cushing syndrome include central obesity, thin and easily

bruisable skin, abdominal striae, secondary hypertension, hyperglycemia and proximal

muscle weakness. Patients can also have hirsutism,

hyperpigmentation, anxiety, depression, osteopenia or

osteoporosis, insulin resistance, dyslipidemia,

decreased libido and an increased susceptibility to

infections. An acronym commonly used for the

characteristics of the side effects of corticosteroids is

CUSHINGOID: cataracts, ulcers, striae/skin thinning,

hypertension/hirsutism/hyperglycemia, infections,

necrosis of femoral head, glucose elevation,

osteoporosis/obesity, immunosuppression,

depression/diabetes.

To diagnose Cushing syndrome, measurements

of cortisol and/or the dexamethasone suppression test are used. Cortisol can be measured in
free urine and/or late-night saliva. To differentiate between primary and secondary forms of

the syndrome, serum ACTH levels are used. Imaging, further hormone testing and bilateral

sampling of the inferior petrosal sinus can also be used to identify the cause of disease.

The treatment for exogenous Cushing syndrome is simply to lower the dose of

glucocorticoids or replace them. For endogenous Cushing syndrome, the first line of therapy

is curative surgery. Patients can develop adrenal insufficiency after surgery and may need

glucocorticoid replacement therapy.

 Works Cited

“Cushing's Syndrome.” National Institute of Diabetes and Digestive and Kidney Diseases,
U.S. Department of Health and Human Services, https://www.niddk.nih.gov/health-
information/endocrine-diseases/cushings-syndrome#:~:text=Cushing's%20syndrome
%20is%20a%20disorder,glucose%2C%20also%20called%20blood%20sugar.

Kim, Jieun. “Cushing's Syndrome.” Toronto Notes 2017, University of Toronto Press,
Toronto, 2017, pp. E32–E33.

Next.amboss.com, https://next.amboss.com/us/article/fg0ku2?q=cushing
%2Bsyndrome#Zd6f2c97ce2ff59be2266a924adc28d81.