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Cortisol affects many organs and systems throughout the body

Almost every cell in your body contains receptors that bind with cortisol. These receptors (called glucocorticoid [gloo-koh-kawr-ti-koid] receptors or GRs) allow cortisol to enter the cell and change its behavior.

Once inside, cortisol makes changes so the body can respond to stress and other conditions in the environment. Although this is important, having too much cortisol may have negative effects throughout the body.

Cortisol changes cell behavior by binding to GRs in cells throughout the body:

Cortisol binding to Glucocorticoid receptor

Symptoms of Cushing syndrome (hypercortisolism) vary from person to person

Everyone may experience symptoms of Cushing syndrome differently and at varying levels of severity.

Some common signs and symptoms include:

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Metabolism Arrow to expand information Common symptoms: Poorly controlled type 2 diabetes mellitus | insulin resistance | obesity

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About 70% to 75%

of people with Cushing syndrome have problems controlling their blood sugar

More than 80%

of people with Cushing syndrome have weight gain and changes in appearance

Learn more about changes in weight and appearance associated with different sources of Cushing syndrome.

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Psychological health Arrow to expand information Common symptoms: Insomnia | difficulty concentrating | changes in mood

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At least 70%

of people with Cushing syndrome have depression or cognitive changes (such as changes in mood, concentration, or memory)

66% to 79%

of people with Cushing syndrome have anxiety

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Cardiovascular system Arrow to expand information Common symptoms: Blood clots | high blood pressure | high cholesterol

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People with Cushing syndrome are at increased risk for heart disease and stroke

Blood clots during surgery are more common in people with Cushing syndrome than in those without the condition

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Immune system Arrow to expand information Common symptoms: Repeated infections

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As Cushing syndrome gets worse, the body may become increasingly susceptible to new or worsening infections

People with Cushing syndrome are more likely to contract infections commonly seen in immunosuppressed people

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Reproductive system Arrow to expand information Common symptoms: Infertility | sexual dysfunction | menstrual irregularity

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24% to 90%

of people with Cushing syndrome have a reduced sex drive

50% to 75%

of men with Cushing syndrome have low testosterone levels (hypogonadism)

43% to 80%

of women with Cushing syndrome have irregular menstrual periods

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Skeletal system Arrow to expand information Common symptoms: Weak bones | osteoporosis | bone fractures

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The percentage of people with Cushing syndrome who have bone loss and spinal fractures may be as high as 10.8%

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Muscular system Arrow to expand information Common symptoms: Muscle weakness | loss of muscle mass

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As Cushing syndrome worsens, muscle mass shrinks

Cortisol activity in skeletal muscles is linked to an inability to use protein to build or maintain muscle mass. As a result, muscles may lose volume (atrophy)

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Cushing’s disease and syndrome: The evolving story of hypercortisolism

In a podcast from Pituitary World News, experts discuss how the understanding of Cushing syndrome has expanded to include a range of symptoms, disease causes, and laboratory test result ranges.


Listen to podcast

Or listen here: Amazon Music | iTunes | Google Podcasts | Spotify

What does Cushing syndrome look like?

Sometimes, Cushing syndrome symptoms may be severe. Other times, symptoms may be mild or less severe with fewer noticeable signs. These differences may have to do with the source of excess cortisol.

Each person pictured below has been diagnosed with Cushing syndrome. There is no single sign or symptom that defines Cushing syndrome. Everyone experiences symptoms differently and at varying levels of severity.

Faces of Hypercortisolism ImageFaces of Hypercortisolism ImagePatients in the above photos were diagnosed with hypercortisolism/Cushing syndrome. Some photographs from: Cushing H. Clinical manifestations of disordered function. In: The Pituitary Body and Its Disorders: Clinical States Produced by Disorders of the Hypophysis Cerebri. Philadelphia, PA: JB Lippincott Company; 1912. All other photographs used with permission.
Jenny Headshot

Jenny's story

"It was scary to know that I had a rare disease. … However, more than anything, I was so relieved to finally know that I wasn’t crazy …”


Read Jenny’s Story

The spectrum of Cushing syndrome

Symptoms caused by excess cortisol, including high blood pressure, obesity, and difficulty controlling blood sugar, may also be common in the general population. As a result, Cushing syndrome may be challenging to diagnose.

Although Cushing syndrome may look different and have many different symptoms, one feature remains consistent: The condition tends to worsen over time. The longer a person is exposed to excess cortisol, the worse the symptoms may become.

Symptoms of Cushing syndrome may differ from person to person. No single sign or symptom points to a diagnosis.

Some symptoms of Cushing syndrome are more obvious than others. These may include:


Image of bruising caused by hypercortisolism called striae

Reddish purple stretch marks (striae)

Image of facial redness caused by hypercortisolism called plethora

Flushed, reddish complexion (plethora)

Image of abnormal hair growth caused by hypercortisolism called hirsutism

Abnormal hair growth (hirsutism)

Image of abnormal bruising caused by hypercortisolism

Easy bruising

Note that these symptoms may vary in intensity and present differently in each patient.

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Could you have Cushing syndrome?

Download this useful checklist of signs and symptoms and review it with your healthcare provider to determine whether screening for Cushing syndrome may be appropriate for you.


Download Checklist

Descargar la lista de síntomas en español.

Different source, different signs and symptoms

Adrenal Cushing syndrome

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Appearance

Adrenal Cushing syndrome may not cause the physical changes more commonly associated with classic, overt cases of this disease. However, people with adrenal Cushing syndrome may still experience negative effects on their health and well-being, such as

  • An inability to control blood sugar
  • Worsening heart and circulatory issues
  • Other signs of excess cortisol

Source

Often caused by a nodule on the adrenal glands that secretes excess cortisol

Pituitary/Ectopic Cushing syndrome

Image of pituitary glandOutline of body inside a circle

Appearance

Pituitary or ectopic Cushing syndrome is associated with the more overt physical changes linked to the condition. These may include

  • Fat buildup in the face (called moon facies)
  • A fat pad on the back (called a buffalo hump)
  • Stretch marks that are reddish purple

Source

Often caused by a source that affects the signaling of the adrenocorticotrophic hormone (ACTH), such as a nodule located on the pituitary or elsewhere in the body

Often caused by a source that affects the signaling of the adrenocorticotrophic hormone
(ACTH), such as a nodule located on the pituitary or elsewhere in the body

If your doctor suspects you may have Cushing syndrome, there are additional screening measures to help make the diagnosis.


Understand the Tests
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