Cushing syndrome due to adrenal tumor
Cushing syndrome due to adrenal tumor is a form of Cushing syndrome. It occurs when a tumor of the adrenal gland releases excess amounts of the hormone cortisol.
Adrenal tumor - Cushing syndrome
Cushing syndrome is a disorder that occurs when your body has a higher than normal level of the hormone cortisol. This hormone is made in the adrenal glands. Too much cortisol can be due to various problems. One such problem is a tumor on one of the adrenal glands. Adrenal tumors release cortisol.
Adrenal tumors are rare. They can be noncancerous (benign) or cancerous (malignant).
Noncancerous tumors that can cause Cushing syndrome include:
- Adrenal adenomas, a common tumor that rarely makes excess cortisol
- Macronodular hyperplasia, which causes the adrenal glands to enlarge and make excess cortisol
Cancerous tumors that may cause Cushing syndrome include an adrenal carcinoma. This is a rare tumor, but it usually makes excess cortisol.
Most people with Cushing syndrome have:
- Round, red, full face (moon face)
- Slow growth rate in children
- Weight gain with fat accumulation on the trunk, but fat loss from the arms, legs, and buttocks (central obesity)
Skin changes that are often seen:
- Skin infections
- Purple stretch marks (1/2 inch or 1 centimeter or more wide), called striae, on the skin of the abdomen, thighs, upper arms, and breasts
- Thin skin with easy bruising
Muscle and bone changes include:
- Backache, which occurs with routine activities
- Bone pain or tenderness
- Collection of fat between the shoulders and above the collar bone
- Rib and spine fractures caused by thinning of the bones
- Weak muscles, especially of the hips and shoulders
Body-wide (systemic) changes include:
- Type 2 diabetes mellitus
- High blood pressure
- Increased cholesterol and triglycerides
Women often have:
- Excess hair growth on the face, neck, chest, abdomen, and thighs (more common than in other types of Cushing syndrome)
- Periods that become irregular or stop
Men may have:
- Decreased or no desire for sex (low libido)
- Erection problems
Other symptoms that may occur include:
- Mental changes, such as depression, anxiety, or changes in behavior
- Increased thirst and urination
Exams and Tests
The health care provider will perform a physical exam and ask about your symptoms.
Tests to confirm Cushing syndrome:
- 24-hour urine sample to measure cortisol and creatinine levels
- Blood tests to check ACTH, cortisol, and potassium levels
- Dexamethasone suppression test
- Blood cortisol levels
- Blood DHEA level
- Saliva cortisol level
Tests to determine cause or complications include:
- Abdominal CT
- Bone mineral density
- Fasting glucose
Surgery is done to remove the adrenal tumor. Often, the entire adrenal gland is removed.
Glucocorticoid replacement treatment is usually needed until the other adrenal gland recovers from surgery. You may need this treatment for 9 to 12 months.
If surgery is not possible, such as in cases of adrenal cancer, medicines can be used to stop the release of cortisol.
People with an adrenal tumor who have surgery have an excellent outlook. For adrenal cancer, surgery is sometimes not possible. When surgery is performed, it does not always cure the cancer.
Cancerous adrenal tumors can spread to the liver or lungs.
When to Contact a Medical Professional
Call your provider if you develop any symptoms of Cushing syndrome.
Appropriate treatment of adrenal tumors may reduce the risk of complications in some people with tumor-related Cushing syndrome.
Nieman LK, Biller BM, Findling JW, et al. Treatment of Cushing's syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(8):2807-2831. PMID: 26222757 www.ncbi.nlm.nih.gov/pubmed/26222757.
Schneider DF, Mazeh H, Lubner SJ, Jaume JC, Chen H. Cancer of the endocrine system. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 71.
Stewart PM, Newell-Price JDC. The adrenal cortex. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier; 2016:chap 15.
Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.