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Welcome to the new Cushing's Help and Support FAQ (frequently asked questions) page. This new area will be a compilation of our visitors most frequent questions. Questions and answers are still being added.

Please select either a category on the left, or type in a keyword to search the database of questions and answers. Please note that there are several questions waiting to be answered at this time. Your question will be answered as soon as possible. If your question is very urgent, you might want to check the message boards to see if your question has been answered, or add it yourself.

IMPORTANT: The information and material posted on this Web site is intended as general reference information only. Specific facts and circumstances may alter the concepts and applications of materials and information described herein. The information provided is not a substitute for professional advice and should not be relied upon in the absence of such professional advice specific to whatever facts and circumstances are presented in any given situation.



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  • Can stress cause Cushing's syndrome?

    Stress-related increased cortisol production by the adrenal glands is normal and physiological, and does not lead to Cushing's syndrome. It can be produced by prolonged, high doses of corticosteroid medications and can also result from adrenal gland tumors producing abnormally excessive amounts of cortisol. One other cause is excessive stimulation of the adrenal glands to produce cortisol by high levels of ACTH hormones secreted by a diseased pituitary gland or other abnormal glands.

    Excerpt from http://www.urologyhealth.org/search/index.cfm?topic=43&search=cancer&searchtype=and

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  • If a person has been diagnosed with Cushing's syndrome, how normal can they expect their life to be?

    The symptoms, disabilities and lifestyle of a person with Cushing's syndrome (CS) depend on the degree of cortisol excess, the duration of the disease, the basic health of the person and especially the type and curability of the syndrome. If it is cured, all of the features of the disease can subside, but this may take as long as two to 18 months. During that time, most people get annoyed and frustrated by the slow improvements in physical changes. The combination of CS and adrenal insufficiency signs and symptoms (e.g., dizziness, weakness, nausea and loss of appetite) decrease as replacement steroid hormones are tapered and adrenal hormone production slowly improves toward normal. Frequent calls and visits to a physician are necessary.

    If the CS is curable, or if medically-induced CS remains, these individuals will have to cope with persistent fatigue, muscle weakness, abdominal and facial weight gain, depression, mood swings and all the other signs and symptoms mentioned earlier. Regular visits to a physician for examinations, blood tests and treatments of infections and complications will be necessary and are often viewed as a severe burden.

    Excerpt from http://www.urologyhealth.org/search/index.cfm?topic=43&search=cancer&searchtype=and

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  • What is the difference between Cushing's Syndrome and Cushing's Disease?

    Any condition that causes the adrenal gland to produce excessive cortisol results in the disorder Cushing's syndrome. Cushing syndrome is characterized by facial and torso obesity, high blood pressure, stretch marks on the belly, weakness, osteoporosis, and facial hair growth in females.

    Cushing's syndrome has many possible causes including tumors within the adrenal gland, adrenal gland stimulating hormone (ACTH) produced from cancer such as lung cancer, and ACTH excessively produced from a pituitary tumors within the brain. ACTH is normally produced by the pituitary gland (located in the center of the brain) to stimulate the adrenal glands' natural production of cortisol, especially in times of stress.

    When a pituitary tumor secretes excessive ACTH, the disorder resulting from this specific form of Cushing's syndrome is referred to as Cushing's disease.

    As an aside, it should be noted that doctors will sometimes describe certain patients with features identical to Cushing's syndrome as having 'Cushingoid' features. Typically, these features are occurring as side effects of cortisone-related medications, such as prednisone and prednisolone.

    From http://www.medicinenet.com/script/main/art.asp?articlekey=9874


    Another answer from http://www.urologyhealth.org/search/index.cfm?topic=43&search=cancer&searchtype=and

    Any condition that causes the adrenal gland to produce excessive cortisol results in the disorder known as Cushing�s syndrome (CS). CS is characterized by facial and torso obesity, high blood pressure, stretch marks on the belly, weakness, osteoporosis and facial hair growthin females.

    CS has many possible causes, including tumors within the adrenal gland, adrenal gland stimulating hormone (ACTH) produced from cancer such as lung cancer and ACTH excessively produced from a pituitary tumor within the brain. ACTH is normally produced by the pituitary gland (located in the center of the brain) to stimulate the adrenal glands� natural production of cortisol, especially in times of stress.

    When a pituitary tumor secretes excessive ACTH, the disorder resulting from this specific form of CS is referred to as Cushing�s disease.

    As an aside, it should be noted that doctors sometimes describe certain patients with features identical to CS as having �Cushingoid� features. Typically, these features are occurring as side effects of cortisone-related medications, such as prednisone and prednisolone.

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  • I was reading about the NIH and clinical trials. What are clinical trials?

    A clinical trial is an organized study conducted in order to answer specific questions about a new treatment or a new way of using a known treatment. Each study tries to increase medical knowledge and to find new and better ways to help patients. Besides studying new drugs, clinical trials study new combinations of drugs already used, new ways of giving treatment, and how changes in lifestyle can help patients. Other clinical trials compare the best known standard therapy with a newer therapy to see if one produces more cures and causes fewer side effects than the other.

    Most clinical trials are carried out in steps called phases. Each phase is designed to find different information. Patients may be eligible for studies in different phases, depending on their general condition, the type and stage of their disorder, and what therapy, if any, they have already had. Patients are seen regularly to determine the effect of the treatment, and treatment is always stopped if side effects become too severe.

    With information about ongoing and upcoming clinical trials around the world and all the latest news on medical advances, this section promises to be yet another important source of information for pituitary patients.

    Many clinical studies to test new methods of treating illnesses can't get enough volunteers to participate, say recent studies and polls. The American Society for Clinical Oncology surveyed 6,000 cancer patients in a poll and found 84% of them either didn't know about clinical studies or didn't think studies were an option for them. The poll found that only 4% of the patients surveyed had participated in a study.

    There may be several reasons why patients aren't participating in clinical studies. One reason may be that since the majority of people who do participate in studies learn about them from their physicians, perhaps doctors themselves are unaware of clinical studies, or the doctors may be deciding ahead of time that some patients won't be eligible for certain studies, and thus don't talk to those patients about study participation.

    Another reason for low participation may be patients' concerns about insurance coverage for the doctor visits, tests, and medicines required for clinical studies. In June 2000, President Clinton announced that Medicare will now reimburse the routine patient care costs of clinical trials to test new therapies. This should help increase the numbers of elderly patients involved in clinical trials. Other insurance plans already often cover study costs. In the survey of cancer patients mentioned earlier, of those who had participated in clinical studies, 86% had secured insurance coverage.

    Other misconceptions that patients have about clinical studies are that they won't get the best treatment if they participate, or they will get a placebo (sugar pill) and be treated like a guinea pig. Besides the fact that clinical studies are subject to very strict rules and guidelines, and are evaluated very carefully before they are even started, participants in studies are fully informed about everything in the study before they make any decision to participate. In that same survey of cancer patients participating in studies, 97% said that they received excellent or good quality care, were treated with dignity, and would recommend participation to others.

    The National Institutes of Health provides complete information about what clinical trials are, what you should know about participation, and what questions to ask if you're considering enrolling in a study. You can find out more here at http://www.cushings-help.com/nih.htm

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  • I keep reading about cortisol. What is it?

    Cushing's syndrome, or hypercortisolism, occurs when the body's tissues are exposed to too much of the hormone cortisol.

    In a healthy person, cortisol is a hormone pumped out every day by the adrenal cortex. The adrenal glands, sit atop the kidneys. Cortisol assists the body to deal with various stresses. It reduces inflammation and immune system function and triggers the breakdown of protein into sugars. The pituitary gland, which lies just beneath the brain, sends the signal that triggers cortisol production, with the peak output occurring around 8 a.m. -- as if nature were providing a jolt to get moving.

    And at normal levels, 25 micrograms per deciliter of blood in the morning and about 5 micrograms at night, cortisol is essential to life. It helps regulate blood pressure, energy production, the ability to fight infections and respond to stress. It also seems to keep the immune system in check so that it doesn't make antibodies that might attack the body's own tissues. And it seems to balance the effects of insulin in breaking down sugar for energy and to regulate the metabolism of proteins, carbohydrates and fats.

    A certain amount of cortisol is necessary for life. Without cortisol even a small amount of stress will kill you. Addison's disease, which President John F. Kennedy had, is a disease which causes low cortisol levels, and which is treated by cortisol replacement therapy.

    But too much cortisol -- whether produced naturally in the body or taken as steroids -- is disastrous, too. It can cause sudden weight gain, especially in the trunk, a florid moon-like face, thin skin, mood changes, muscle weakness, purple stretch marks on the torso, high blood pressure, diabetes, a fatty "buffalo" hump on the neck, depression, and severe osteoporosis.

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  • Are there other people with Cushing's that I can talk to?

    Absolutely! There are wonderful Message Boards on every imaginable topic.

    Every Wednesday night at 9 PM Eastern, we have a live chat. We discuss Cushing's, troubles with diagnosis, symptoms and much more. The chatroom is open 24/7 and it is located on the message boards.

    In addition, we also have periodic meetings and retreats. Information about those is always posted on the introduction to the website and for longer range planning, on the Meetings page. You can list a new meeting or discuss plans on the Meetings Topic on the boards.



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  • What Causes Cushing's?

    When cortisol or other glucocorticoid hormones (such as hydrocortisone, prednisone, methyl-prednisolone or dexamethasone) are taken in excess of the normal daily requirement for a prolonged period of time, it causes Cushing's syndrome. This "iatrogenic" (caused by the treatment) form is unfortunately a necessary side effect when high doses of these steroid hormones must be used to treat certain life-threatening illnesses, such as asthma, rheumatoid arthritis, systemic lupus, inflammatory bowel disease, some allergies, and others.

    Spontaneous overproduction of cortisol in the adrenals is divided into two groups - those due to an excess of ACTH and those that are independent of ACTH. A pituitary tumor producing too much ACTH, stimulating the adrenals to grow (hyperplasia) and to produce to much cortisol, is the most common type, and this is called Cushing's disease. It is the cause of 70% of spontaneous Cushing's syndrome. ACTH can also be produced outside the pituitary in a benign or malignant tumor in the lung, thymus gland, pancreas, or other organ. This is called "ectopic" ACTH production.

    When the source of excess cortisol production is a tumor of the adrenal gland itself, then it is not dependent on ACTH. The tumor makes cortisol on its own, and the other adrenal gland shrinks because ACTH production is suppressed. Adrenal cortex tumors can be benign (an adenoma), or malignant (a carcinoma) and are usually found on only one side. A very rare type is caused by multiple benign adenomas on both sides.

    Although almost all types of spontaneous Cushing's Syndrome are ultimately caused by one type of tumor or another, little is known about what makes these tumors occur. There does not appear to be any specific genetic, immune, or environmental factor.

    Written by: Paul Margulies, M.D., F.A.C.P., F.A.C.E. Medical Director of NADF Clinical Associate Professor of Medicine, Cornell University Medical College and posted at http://www.medhelp.org/www/nadf4.htm

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  • What is a brief description of Cushing's?

    Cushing's is a hormonal disorder caused by prolonged exposure of the body's tissues to high levels of the hormone cortisol. Sometimes called "hypercortisolism," it is relatively rare and most commonly affects adults aged 20 to 50. An estimated 10 to 15 of every million people are affected each year.

    Your adrenal glands, which are right above your kidneys, release cortisol when they receive a chemical message from your pituitary gland. The message comes in the form of adrenocorticotrophic hormone (ACTH), which travels through the bloodstream.

    Cushing's Disease: Is the result of a pituitary tumor which causes the emergence of secondary male characteristics (like hair growth, acne, etc.), and ovarian failure. Other symptoms usually include high blood pressure and water retention.

    Cushing's Syndrome: Causes the same symptoms, but is a disorder marked by overproduction of adrenal hormones, which can cause a drop in LH and FSH.

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  • What is the difference between Cushing's Syndrome and Cushing's Disease?

    Cushing's Syndrome is a disease caused by an excess of cortisol production or by excessive use of cortisol or other similar steroid (glucocorticoid) hormones.

    Cortisol is a normal hormone produced in the outer portion, or cortex, of the adrenal glands, located above each kidney. The normal function of cortisol is to help the body respond to stress and change. It mobilizes nutrients, modifies the body's response to inflammation, stimulates the liver to raise the blood sugar, and it helps control the amount of water in the body. Another adrenal cortex hormone, aldosterone, regulates salt and water levels which affects blood volume and blood pressure. Small amounts of androgens (male hormones) are also normally produced in the adrenal cortex. Cortisol production is regulated by adrenocorticotrophic hormone (ACTH), made in the pituitary gland, which is located just below the brain.

    When too much cortisol is produced in the adrenal glands, or an excess is taken in treating other diseases, significant changes occur in all of the tissues and organs of the body. All of these effects together are called Cushing's Syndrome.

    Cushing's disease is the name given to a type of Cushing's Syndrome caused by too much ACTH production in the pituitary. Dr. Harvey Cushing first described a woman with signs and symptoms of this disease in 1912, and in 1932 he was able to link the adrenal overproduction of cortisol to an abnormality in the pituitary.

    Written by: Paul Margulies, M.D., F.A.C.P., F.A.C.E. Medical Director of NADF Clinical Associate Professor of Medicine, Cornell University Medical College and posted at http://www.medhelp.org/www/nadf4.htm

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  • What causes Cushing's?

    Cushing's syndrome occurs when the body's tissues are exposed to excessive levels of cortisol for long periods of time. Many people suffer the symptoms of Cushing's syndrome because they take glucocorticoid hormones such as prednisone for asthma, rheumatoid arthritis, lupus or other inflammatory diseases.

    Others develop Cushing's syndrome because of overproduction of cortisol by the body. Normally, the production of cortisol follows a precise chain of events. First, the hypothalamus, a part of the brain which is about the size of a small sugar cube, sends corticotropin releasing hormone (CRH) to the pituitary gland. CRH causes the pituitary to secrete ACTH (adrenocorticotropin), a hormone that stimulates the adrenal glands. When the adrenals, which are located just above the kidneys, receive the ACTH, they respond by releasing cortisol into the bloodstream.

    Cortisol performs vital tasks in the body. It helps maintain blood pressure and cardiovascular function, reduces the immune system's inflammatory response, balances the effects of insulin in breaking down sugar for energy, and regulates the metabolism of proteins, carbohydrates, and fats. One of cortisol's most important jobs is to help the body respond to stress. For this reason, women in their last 3 months of pregnancy and highly trained athletes normally have high levels of the hormone. People suffering from depression, alcoholism, malnutrition and panic disorders also have increased cortisol levels.

    When the amount of cortisol in the blood is adequate, the hypothalamus and pituitary release less CRH and ACTH. This ensures that the amount of cortisol released by the adrenal glands is precisely balanced to meet the body's daily needs. However, if something goes wrong with the adrenals or their regulating switches in the pituitary gland or the hypothalamus, cortisol production can go awry.

    Pituitary Adenomas
    Pituitary adenomas cause most cases of Cushing's syndrome. They are benign, or non-cancerous, tumors of the pituitary gland which secrete increased amounts of ACTH. Most patients have a single adenoma. This form of the syndrome, known as "Cushing's disease," affects women five times more frequently than men.

    Ectopic ACTH Syndrome
    Some benign or malignant (cancerous) tumors that arise outside the pituitary can produce ACTH. This condition is known as ectopic ACTH syndrome. Lung tumors cause over 50 percent of these cases. Men are affected 3 times more frequently than women. The most common forms of ACTH-producing tumors are oat cell, or small cell lung cancer, which accounts for about 25 percent of all lung cancer cases, and carcinoid tumors. Other less common types of tumors that can produce ACTH are thymomas, pancreatic islet cell tumors, and medullary carcinomas of the thyroid.

    Adrenal Tumors
    Sometimes, an abnormality of the adrenal glands, most often an adrenal tumor, causes Cushing's syndrome. The average age of onset is about 40 years. Most of these cases involve non-cancerous tumors of adrenal tissue, called adrenal adenomas, which release excess cortisol into the blood.

    Adrenocortical carcinomas, or adrenal cancers, are the least common cause of Cushing's syndrome. Cancer cells secrete excess levels of several adrenal cortical hormones, including cortisol and adrenal androgens. Adrenocortical carcinomas usually cause very high hormone levels and rapid development of symptoms.

    Familial Cushing's Syndrome
    Most cases of Cushing's syndrome are not inherited. Rarely, however, some individuals have special causes of Cushing's syndrome due to an inherited tendency to develop tumors of one or more endocrine glands. In Primary Pigmented Micronodular Adrenal Disease, children or young adults develop small cortisol-producing tumors of the adrenal glands. In Multiple Endocrine Neoplasia Type I (MEN I), hormone secreting tumors of the parathyroid glands, pancreas and pituitary occur. Cushing's syndrome in MEN I may be due to pituitary, ectopic or adrenal tumors.

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