What is Cushing syndrome?

On the top of our kidneys, you can find two small glands in the shape of pyramids – they are called the adrenal glands. These glands produce many different hormones, but some very important are the corticosteroids. The most famous of corticosteroids is cortisol. Cortisol is mainly responsible for the control other the creation of sugar (glucose) in our body tissues.

As you may guess, it has the power to makes us “fatter”, which is the reason why stressed out people often gain some weight. It is for sure an important function, so it has to be monitored by our brain.

Indeed, the production of the adrenal glands is checked and controlled by another gland, the pituitary gland, that is directly connected to our brain (more precisely the hypothalamus). It communicates with the adrenal gland through another hormone – ACTH.

So, if I had to draw a scheme, it would be :

Hypothalamus (brain) → Pituitary gland ==releases => ACTH → Adrenal glands =releases=> cortisol

  • Cushing’s syndrome is the name given to the overall manifestations of hypercorticism – a barbarian word to say that you simply produce too much corticosteroids.
  • Cushing’s disease is a more specific term. It says that we produce too much corticosteroids because there is a (benign) tumor in our pituitary gland. As a consequence, the pituitary gland keeps on ordering the adrenal gland to produce too much cortisol !

So, here I have a funny little drawing to explain to you what happens to our body.

As you may see, a patient with Cushing’s will display some unique features :

  • He has too much weight, located on the face (moon face) and a big neck (buffalo hump). His cheeks are also red. He looses hair.
  • His abdomen is pendulous.
  • He lacks muscular strength, especially in arms and legs. He cannot stand up normally.
  • His skin is thin, it bruises easily and displays purple striae = stretch marks that one has when he gains (or looses) weight really fast. The skin may also be bronzed a little bit. Wounds are slow to be healed.
  • The patient has osteoporosis, which means that your bones are really weak and easily broken.
  • Cortisol has also an androgenic action : acne and seborrhea are often visible. Patients of both sex lose hair around their temples but at the same time, women can gain hair in more masculine places (moustaches) – we can say that bodily and facial hair are increased for them.

There are 3 main explanations for the Cushing syndrome :

  • The adrenal glands can directly decide to produce too much cortisol.
  • Too much ACTH can be created by pituitary gland, which rushes the production of cortisol in pituitary glands. It is due to a benign form of tumor (adenoma). It’s what is called Cushing disease.
  • ACTH can be created somewhere else than in the pituitary gland. It is some kind of “shunt”.