Cushing's Syndrome: Signs & Symptoms

Cortisol excess produces significant and serious change in the appearance and health of affected individuals. Depending on the cause and duration of the Cushing's Syndrome, some people may have more dramatic changes, some might look more masculinized, some may have more blood pressure or weight changes. Generally, the longer Cushing’s Syndrome exists prior to treatment, the more symptoms the person will exhibit.
General physical features include a tendency to gain weight (an average of 55 pounds was reported in one study), especially on the abdomen, face (moon face), neck and upper back (buffalo hump); thinning and weakness of the muscles of the upper arms and upper legs; thinning of the skin, with easy bruising and pink or purple stretch marks (striae) on the abdomen, thighs, breasts and shoulders; increased acne, facial hair growth, and scalp hair loss in women; sometimes a ruddy complexion on the face and neck; often a skin darkening (acanthosis) on the neck. Children will show obesity and poor growth in height.
As weight gain/obesity is one of the most earliest and troublesome signs, it is worthwhile to spend some time noting why this weight gain occurs. Excessive cortisol levels do stimulate appetite and account for the rapid weight gain that occurs with Cushing's syndrome. There are several possible mechanisms by which patients with Cushing's have increased appetite. Insulin resistance associated with high insulin levels may be a cause since insulin plays a regulatory role on hunger and satiety. Also, some of the adipokines (leptin, resistin, adiponectin), fat cell chemicals that affect energy regulation are affected by cortisol and may disrupt the physiological control of energy metabolism and cause increased hunger.
On physical examination, a physician will notice these changes and will also usually find high blood pressure and evidence of muscle weakness in the upper arms and legs, and sometimes some enlargement of the clitoris in females.
Symptoms also usually include fatigue, weakness, depression, mood swings, increased thirst and urination, and lack of menstrual periods in women.
Common findings on routine laboratory tests in people with Cushing's Syndrome include a higher white blood count, a high blood sugar (often into the diabetic range), and a low serum potassium. These will often reinforce a physician's suspicion about Cushing's Syndrome. Ectopic Cushing's Syndrome tends to present with less impressive classic features, but more dramatic hypertension and loss of potassium, sometimes in the setting of weight loss from the underlying cancer.
Most people who appear to have some of the classic physical features of Cushing's Syndrome (cushingoid appearance) do not actually have the disease. After iatrogenic Cushing's is excluded, other causes of this appearance can be polycystic ovary syndrome (androgen excess from the ovaries), ovarian tumors, congenital adrenal hyperplasia, ordinary obesity, excessive alcohol consumption, or just a family tendency to have a round face and abdomen with high blood pressure and high blood sugar.
If untreated, Cushing's Syndrome will cause continued weakness of the muscles, fatigue, poor skin healing, weakening of the bones of the spine (osteoporosis), and increased susceptibility to some infections including pneumonia and TB. Patients with severe hypercortisolism may develop many of the same infections seen in patients with AIDS, such as tuberculosis, pneumoncystis, and fungal infections