12 Common Symptoms of Cushing Syndrome You Should Know

Cushing syndrome is a hormonal disorder that occurs when your body is exposed to high levels of the hormone cortisol for an extended period. This condition, also known as hypercortisolism, can develop from various causes and affects multiple body systems. Understanding the symptoms of Cushing syndrome is crucial for early detection and proper medical intervention.

Cortisol is a vital hormone produced by the adrenal glands that helps regulate metabolism, blood pressure, immune response, and stress reactions. However, when cortisol levels remain consistently elevated, it can lead to a wide range of physical and psychological symptoms that significantly impact quality of life.

In this comprehensive guide, we’ll explore the most common symptoms of Cushing syndrome to help you recognize the warning signs and understand when to seek medical attention.

1. Rapid Weight Gain and Fat Redistribution

One of the most characteristic symptoms of Cushing syndrome is unusual weight gain with a distinctive pattern of fat distribution. Unlike typical weight gain that affects the entire body relatively evenly, Cushing syndrome causes fat to accumulate primarily in specific areas.

Patients typically experience:

• Significant weight gain in the face, creating a rounded, moon-shaped appearance often called “moon face”
• Fat accumulation in the upper back and neck, forming what’s commonly referred to as a “buffalo hump”
• Increased abdominal and trunk fat while arms and legs may remain relatively thin
• This central obesity pattern combined with thin extremities creates a distinctive body shape

This redistribution occurs because excess cortisol affects how and where the body stores fat. The contrast between a fuller face and torso with thinner limbs is often one of the first visible signs that prompt people to seek medical evaluation.

2. Purple or Pink Stretch Marks (Striae)

People with Cushing syndrome often develop wide, purple or pink stretch marks that are notably different from the typical stretch marks associated with pregnancy or normal weight gain. These distinctive marks, medically known as striae, are considered one of the hallmark signs of the condition.

These stretch marks typically:

• Appear as broad bands, often wider than 1 centimeter
• Display a deep purple, red, or pink coloration rather than the silvery-white color of older stretch marks
• Most commonly develop on the abdomen, breasts, thighs, and upper arms
• Result from the weakening of collagen in the skin caused by excess cortisol

The skin becomes fragile and tears more easily under the stress of weight gain and fat redistribution, creating these characteristic marks. Their distinctive appearance and location can help healthcare providers distinguish Cushing syndrome from other conditions.

3. Thinning Skin and Easy Bruising

Elevated cortisol levels significantly affect skin integrity, leading to skin that becomes noticeably thinner and more fragile. This symptom can manifest in various ways and often causes considerable concern for patients.

Common manifestations include:

• Skin that appears translucent or paper-thin, particularly on the hands and arms
• Bruises that appear with minimal trauma or even without any remembered injury
• Bruises that are larger than expected for the level of impact
• Slow healing of minor cuts, scrapes, and wounds
• Increased visibility of veins beneath the skin surface

This occurs because cortisol breaks down collagen and other proteins that maintain skin structure and elasticity. The weakened skin tears more easily internally, causing bruising, and lacks the robust healing capacity of healthy skin.

4. Facial Rounding and Increased Facial Hair

The face undergoes significant changes in people with Cushing syndrome, creating a distinctive appearance that often helps with diagnosis. Beyond the overall rounding of the face, other facial changes occur simultaneously.

Facial symptoms include:

• Progressive rounding of the face, losing its natural contours and creating the characteristic “moon face” appearance
• Facial plethora – a reddish or flushed appearance to the cheeks and face that may be mistaken for rosacea or high blood pressure
• Increased facial hair growth in women (hirsutism), particularly on the upper lip, chin, and sides of the face
• Development or worsening of acne, particularly in adults who previously had clear skin

These changes result from both fat redistribution and the effects of excess cortisol and androgens (male hormones) that often accompany high cortisol levels. In women, the increased facial hair can be particularly distressing and is often one of the symptoms that prompts medical consultation.

5. Muscle Weakness and Decreased Muscle Mass

High cortisol levels have a catabolic effect on muscle tissue, meaning they break down proteins in muscles. This leads to progressive muscle weakness and wasting that can significantly impact daily activities and quality of life.

Patients typically experience:

• Difficulty rising from a seated position or climbing stairs without using arms for support
• Weakness particularly noticeable in the proximal muscles (those closest to the body’s center), especially in the hips and shoulders
• Visible reduction in muscle bulk, particularly in the arms and legs
• Decreased stamina and endurance during routine activities
• Difficulty lifting objects that were previously manageable

This muscle weakness, known as proximal myopathy, occurs because cortisol promotes the breakdown of muscle protein while simultaneously inhibiting protein synthesis. The combination of muscle loss in the limbs with fat accumulation in the trunk creates the characteristic body composition changes seen in Cushing syndrome.

6. Hypertension (High Blood Pressure)

Elevated blood pressure is an extremely common finding in Cushing syndrome, affecting the majority of patients. This symptom is particularly important because it increases the risk of serious cardiovascular complications if left untreated.

High blood pressure in Cushing syndrome:

• Often develops gradually and may be detected during routine medical checks
• Can be resistant to standard blood pressure medications
• Results from cortisol’s effects on blood vessel tone and sodium retention
• Increases the risk of heart disease, stroke, and kidney damage
• May be present without symptoms, making regular monitoring essential

Cortisol raises blood pressure through multiple mechanisms, including increasing the sensitivity of blood vessels to constricting substances, promoting sodium and water retention by the kidneys, and affecting the production of other hormones that regulate blood pressure. Some patients may experience headaches or dizziness related to elevated blood pressure.

7. Glucose Intolerance and Diabetes

Excess cortisol significantly disrupts the body’s ability to regulate blood sugar levels, leading to glucose intolerance or overt diabetes mellitus. This metabolic complication is one of the most serious aspects of Cushing syndrome.

Blood sugar-related symptoms include:

• Development of type 2 diabetes or worsening control of previously well-managed diabetes
• Increased thirst and frequent urination as blood sugar levels rise
• Fatigue and hunger despite adequate food intake
• Elevated fasting blood glucose and hemoglobin A1c levels on laboratory testing
• Insulin resistance that makes blood sugar difficult to control

Cortisol raises blood glucose by promoting gluconeogenesis (the production of glucose from non-carbohydrate sources), decreasing insulin sensitivity in tissues, and reducing glucose uptake by cells. This creates a state of insulin resistance that can progress to diabetes if the excess cortisol continues.

8. Osteoporosis and Bone Fractures

High cortisol levels have devastating effects on bone health, leading to accelerated bone loss and increased fracture risk. This symptom may not be immediately apparent but can have serious long-term consequences.

Bone-related problems include:

• Decreased bone density (osteoporosis) that develops more rapidly than typical age-related bone loss
• Fractures that occur with minimal trauma, particularly in the ribs, spine, and hips
• Compression fractures of the vertebrae leading to back pain and height loss
• Increased risk of fractures during routine activities
• Bone pain or tenderness in some cases

Cortisol inhibits the activity of osteoblasts (cells that build bone) while promoting the activity of osteoclasts (cells that break down bone). It also decreases calcium absorption from the intestine and increases calcium excretion by the kidneys. These combined effects create a state of rapid bone loss that can lead to serious skeletal complications.

9. Mood Changes and Psychological Symptoms

The psychological and emotional effects of Cushing syndrome are significant and can sometimes be as debilitating as the physical symptoms. High cortisol levels directly affect brain chemistry and function.

Common psychological symptoms include:

• Depression characterized by persistent sadness, loss of interest in activities, and feelings of hopelessness
• Anxiety disorders with excessive worry, restlessness, and panic symptoms
• Irritability and mood swings that may strain relationships
• Cognitive difficulties including problems with memory, concentration, and mental clarity often described as “brain fog”
• In severe cases, psychosis with hallucinations or delusions, though this is less common

These symptoms occur because cortisol affects neurotransmitter systems in the brain, particularly those involving serotonin and dopamine. The mood and cognitive changes can sometimes be the most distressing aspects of the condition and may significantly impact work performance, relationships, and overall quality of life.

10. Irregular Menstrual Periods and Reduced Fertility

Women with Cushing syndrome commonly experience significant disruptions to their reproductive system. The hormonal imbalances caused by excess cortisol affect the entire reproductive axis.

Reproductive symptoms in women include:

• Irregular menstrual cycles with periods that may become infrequent, irregular, or stop completely (amenorrhea)
• Reduced fertility and difficulty conceiving
• Increased androgen levels leading to masculine features such as increased body and facial hair (hirsutism)
• Acne and oily skin
• Decreased libido (sex drive)

In men, Cushing syndrome can also affect reproductive function:

• Decreased libido and erectile dysfunction
• Reduced testosterone levels
• Decreased fertility

These reproductive effects occur because excess cortisol disrupts the hypothalamic-pituitary-gonadal axis, reducing the production of reproductive hormones. Additionally, the associated elevation in androgens contributes to many of the symptoms seen in women.

11. Increased Susceptibility to Infections

One of cortisol’s normal functions is to modulate immune system activity. However, chronically elevated cortisol levels suppress immune function, making individuals with Cushing syndrome more vulnerable to infections.

Immune-related symptoms include:

• Frequent infections, particularly respiratory infections, urinary tract infections, and skin infections
• Infections that are more severe or last longer than typical
• Fungal infections, including oral thrush (candidiasis) and skin fungal infections
• Poor wound healing that increases the risk of wound infections
• Slower recovery from common illnesses

Cortisol suppresses various aspects of immune function, including the activity of white blood cells, antibody production, and inflammatory responses. While cortisol’s anti-inflammatory properties can be beneficial in certain medical conditions, chronic excess leaves the body unable to mount effective immune responses against pathogens.

12. Fatigue and Decreased Energy

Persistent fatigue is one of the most common and debilitating symptoms of Cushing syndrome. This exhaustion goes beyond normal tiredness and can significantly impair daily functioning.

Characteristics of Cushing-related fatigue include:

• Overwhelming tiredness that doesn’t improve with rest or sleep
• Difficulty completing routine daily activities due to lack of energy
• Need for frequent rest periods throughout the day
• Physical exhaustion combined with muscle weakness making exertion particularly difficult
• Mental fatigue affecting concentration and productivity

This fatigue results from multiple factors including muscle weakness, metabolic disturbances, poor sleep quality, and the direct effects of cortisol on energy metabolism. Many patients report that fatigue is one of their most frustrating symptoms because it limits their ability to work, exercise, and engage in social activities. The fatigue often improves dramatically when cortisol levels are brought back to normal ranges.

Main Causes of Cushing Syndrome

Understanding what causes high cortisol levels is essential for proper diagnosis and management. Cushing syndrome can result from various underlying conditions, which are generally classified as either ACTH-dependent or ACTH-independent causes.

Exogenous Causes (Most Common)

Long-term use of corticosteroid medications: This is the most common cause of Cushing syndrome. Corticosteroids such as prednisone, dexamethasone, and prednisolone are prescribed for various conditions including autoimmune diseases, asthma, inflammatory conditions, and after organ transplants. When taken in high doses or for extended periods, these medications can cause the same symptoms as naturally occurring Cushing syndrome.

Endogenous Causes (Natural Overproduction)

Pituitary adenomas (Cushing’s disease): The most common endogenous cause is a benign tumor of the pituitary gland that secretes excessive amounts of ACTH (adrenocorticotropic hormone). This excess ACTH stimulates the adrenal glands to produce too much cortisol. When Cushing syndrome is caused by a pituitary tumor, it’s specifically called Cushing’s disease. This accounts for approximately 70% of endogenous cases.

Adrenal gland tumors: Benign adenomas or, less commonly, malignant carcinomas of the adrenal glands can produce cortisol independently, without ACTH stimulation. These tumors directly secrete cortisol into the bloodstream, causing Cushing syndrome.

Ectopic ACTH syndrome: Some tumors outside the pituitary gland can produce ACTH, leading to excess cortisol production. These tumors are most commonly found in the lungs (small cell lung cancer, carcinoid tumors), pancreas, thyroid, or thymus gland. This cause represents about 10-15% of endogenous Cushing syndrome cases.

Ectopic CRH secretion: Rarely, tumors can secrete corticotropin-releasing hormone (CRH), which stimulates the pituitary to produce ACTH, subsequently causing the adrenal glands to produce excess cortisol.

Primary pigmented nodular adrenocortical disease and McCune-Albright syndrome: These rare genetic conditions can cause Cushing syndrome, typically presenting in children and young adults.

Frequently Asked Questions

What is Cushing syndrome and how is it different from Cushing’s disease?

Cushing syndrome is a general term for any condition where the body is exposed to high levels of cortisol for an extended period. Cushing’s disease is a specific type of Cushing syndrome caused by a pituitary tumor that secretes excess ACTH. In other words, all cases of Cushing’s disease are Cushing syndrome, but not all Cushing syndrome is Cushing’s disease.

What does high cortisol mean for my health?

High cortisol means your body has excessive amounts of this stress hormone circulating in your bloodstream. While cortisol is essential for normal body functions, chronically elevated levels can lead to numerous health problems including weight gain, high blood pressure, diabetes, weakened bones, increased infection risk, and psychological symptoms. It’s important to identify the cause and address it to prevent long-term complications.

Are symptoms of high cortisol different in females compared to males?

While many symptoms are similar in both sexes, women with high cortisol often experience additional reproductive symptoms including irregular or absent menstrual periods, increased facial and body hair growth (hirsutism), acne, and fertility problems. Men may experience decreased libido, erectile dysfunction, and reduced fertility. Both sexes experience the characteristic weight gain, skin changes, muscle weakness, and other common symptoms.

How quickly do Cushing syndrome symptoms develop?

The onset of symptoms typically occurs gradually over months to years, making early recognition challenging. Some people may notice changes within several months, while others may experience a slower progression over several years. The speed of symptom development often depends on the underlying cause and the degree of cortisol elevation. Exogenous Cushing syndrome from medications may develop more quickly than endogenous causes.

Can Cushing syndrome go away on its own?

Cushing syndrome does not resolve spontaneously and requires medical intervention. If caused by corticosteroid medications, it may resolve after the medications are discontinued under medical supervision. However, endogenous Cushing syndrome caused by tumors or gland abnormalities requires specific treatment addressing the underlying cause. Without treatment, the condition typically worsens over time and can lead to serious complications.

What should I do if I suspect I have symptoms of Cushing syndrome?

If you’re experiencing multiple symptoms suggestive of Cushing syndrome, you should consult your healthcare provider promptly. They can perform initial screening tests including blood and urine cortisol measurements. Early diagnosis is important because untreated Cushing syndrome can lead to serious complications. Keep a record of your symptoms, when they started, and any medications you’re taking to help your doctor with the evaluation.

How is Cushing syndrome diagnosed?

Diagnosis involves multiple steps including clinical evaluation of symptoms, measurement of cortisol levels through various tests (24-hour urine cortisol, late-night salivary cortisol, low-dose dexamethasone suppression test), and determining the underlying cause through imaging studies (MRI or CT scans) and additional hormone testing. Because cortisol levels can fluctuate, multiple tests are usually needed to confirm the diagnosis.

Is cortisol imbalance the same as Cushing syndrome?

Not necessarily. Cortisol imbalance is a general term that can refer to either too much or too little cortisol, or irregular cortisol patterns. Cushing syndrome specifically refers to excessive cortisol levels. Cortisol can be temporarily elevated due to stress, illness, or other factors without meeting the criteria for Cushing syndrome, which involves persistent elevation. Proper medical evaluation is needed to distinguish between temporary fluctuations and true Cushing syndrome.

References:

• Mayo Clinic – Cushing Syndrome
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
• Johns Hopkins Medicine – Cushing’s Disease
• Endocrine Society – Cushing’s Syndrome
• National Center for Biotechnology Information (NCBI) – Cushing Syndrome