Cushing's Syndrome

This Side Effect Of Steroids Can Occur With Long-Term Use

A disorder that occurs when the body is exposed to too much cortisol. Cortisol is a hormone that is produced by the body and is also found in corticosteroid drugs. Cushing's syndrome can occur either because cortisol is being overproduced by the body or from the use of drugs that contain cortisol (like prednisone). When Cushing's syndrome is caused by long-term use of corticosteroid medications, it is also called hypercortisolism.

There can be other causes of Cushing's syndrome, such as a tumor. Cushing's syndrome is considered rare.

In general, physicians will work towards getting patients weaned off steroid drugs such as prednisone as soon as possible. In the treatment of inflammatory bowel disease (IBD), the goal is to get patients into remission (reducing inflammation and symptoms) without steroids or with the very limited use of steroids. This is because steroids, while extremely effective, can have profound and long-lasting effects on the body, including the development of Cushing's syndrome. However, the judicious use of steroids might be warranted in some cases: it is a treatment choice that should be discussed carefully. If you have questions about the use of steroids and the potential risk versus the benefits in your particular case, talk to your gastroenterologist.

What Causes Cushing's Syndrome?

Cortisol is a substance that is naturally produced by the body, especially during times of stress.

Cortisol has several functions, including the regulation of inflammation and controlling how the body uses carbohydrates, fats, and proteins. Corticosteroids such as prednisone, which are often used to treat inflammatory conditions such as Crohn's disease and ulcerative colitis, mimic the effects of cortisol.


What Are The Signs and Symptoms of Cushing's Syndrome?

Signs and symptoms of Cushing’s syndrome can include:

  • anxiety
  • depression
  • elevated glucose levels
  • excessive thirst
  • fatigue
  • fatty hump between the shoulders
  • frequent urination
  • high blood pressure
  • muscle weakness
  • rounded face
  • stretch marks on the abdomen, arms, breasts, buttocks, and thighs (also called striae)
  • weight gain in the upper body

There could be other signs and symptoms of this condition that are not covered above. If you have concerns that you have several of the symptoms of Cushing's syndrome, talk to your physician.

How Is Cushing's Syndrome Treated?

How Cushing's syndrome is treated by lowering the levels of cortisol in the body. In the case of an the underlying condition, such as a pituitary gland tumor or adrenal gland disease, more specific treatment will be needed. In the case of drug-induced Cushing's syndrome, the dosage of corticosteroids may need to be tapered down and possibly discontinued. It is very important to slowly decrease the amount of corticosteroid taken over the course of weeks or even months. Stopping the drug suddenly can have serious effects on the body.

If the steroids can't be stopped, or if it is going to take a long time to stop them, other treatments might be given to manage some of the signs and symptoms of Cushing's syndrome.

Some of the aspects of this syndrome that might need treatment with other medications and changes to the diet include high blood sugar and high cholesterol. Reducing the risk of fractures with medications used to treat osteoporosis might also be necessary. In the case of depression or anxiety, referral to a mental health specialist for treatment may also be effective.

Patients can also take some steps at home to treat the effects of Cushing's syndrome. Monitoring diet closely to avoid weight gain and high blood sugar levels, getting regular physician-recommended exercise, and instituting self-care measures to avoid stress can all help.


The Bottom Line

Cushing's syndrome is a risk of taking steroid medications, but it is rare. Cushing's syndrome can be treated by lowering the amount of steroids being taken, and by treating some of the signs and symptoms. The goal is always to get patients off steroids as quickly and as safely as possible.

Also Known As: hypercortisolism


National Institutes of Health. "Cushing's Syndrome." National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Apr 2012.

Sharma ST, Nieman LK. "Cushing's syndrome: all variants, detection, and treatment." Endocrinol Metab Clin North Am. 2011 Jun;40:379-391, viii-ix.