Cushing's Syndrome Signs and Symptoms

The signs and symptoms of Cushing’s syndrome vary from mild to severe, depending on the level of cortisol hormone in the body. Changes in body appearance are common in individuals with Cushing’s syndrome, including alterations in the body weight and the appearance of the skin.

Signs and symptoms of Cushing's syndrome. Image Copyright: Designua / Shutterstock

Weight

Many patients experience weight gain and an increase in fatty tissue, primarily concentrated around the midsection, upper back, in the face and between the shoulders. This is called central obesity, and can result in the characteristic appearance of an individual with the condition, who is described as having a “moon face” and “buffalo hump”.

The changes in the cortisol levels cause this abnormal redistribution of fat. As a result, the arms and legs often appear to be abnormally thin as compared to the chest, stomach and face of the affected individuals.

Skin Changes

Striae, also known as stretch marks, are also often visible on the abdomen, thighs, buttocks, breasts and arms. In these areas, the skin may show pinkish or purplish lines, a few millimeters thick, where the skin has stretched. There may also be a general darkening of the skin around the neck. Spots may be evident on the face, chest or shoulders.

The strength and healing ability of the skin may also be affected. Patients with Cushing’s syndrome often have thin, fragile skin that is broken or bruised easily. Additionally, minor skin injuries such as cuts or insect bites are usually slow to heal. Skin infections are more common. Individuals with Cushing’s syndrome are also more likely to be affected by acne and other skin conditions.

These effects are also due to the increased cortisol levels in the body, which causes certain skin proteins to be broken down, with weakening of the blood vessels.

Bones and Muscles

The excessive levels of cortisol in the body that are seen in patients with Cushing’s syndrome can cause weakening of the bones and muscles. This may become symptomatic following routine activities, such as:

• Back pain
• Bone pain
• Susceptibility to bone fractures, especially of the ribs and spine
• Reduced height
• Kyphosis (curvature of the spine)

Additionally, reduced bone density increases the risk of osteoporosis and bone fractures, particularly later in life.

Psychological Symptoms

Patients with Cushing’s syndrome are prone to feeling fatigued easily. This may be linked to feelings of depression and other psychological symptoms, such as:

• Sadness and anxiety
• Irritability and anger
• Reduced control over one’s emotions

The affected individuals are more likely to experience mood swings and to have difficulty in controlling strong emotions. For this reason, they may sometimes have inappropriate reactions, such as laughing or crying at unexpected moments.

General Symptoms

There is a range of symptoms that may be reported by patients with Cushing’s syndrome, including:

• Fatigue
• Hypertension
• Headache
• Peripheral edema
• Excessive sweating
• Kidney stones
• Hyperglycemia

Children affected by Cushing’s syndrome may have impaired growth in respect to the average for their age, and are more likely to be obese than other children.

Gender-specific Symptoms

Women with Cushing’s syndrome may experience hirsutism, which is a condition involving the appearance of new body and facial hair, or the increase in thickness of existing hair. Additionally, many women report that they suffer from an increased irregularity of menstrual periods, and some may even have amenorrhea, or the complete absence of menstruation for over six months.  

Men with Cushing’s syndrome may often notice a reduction in libido and sex drive. They may have erectile dysfunction and testing may reveal a reduced sperm count, both of which can contribute to decreased fertility.

References

• http://www.mayoclinic.org/diseases-conditions/cushing-syndrome/symptoms-causes/dxc-20197177
• http://www.nhs.uk/Conditions/Cushings-syndrome/Pages/Symptoms.aspx
• https://pituitarysociety.org/patient-education/pituitary-disorders/cushings/symptoms-of-cushings-disease-and-cushings-syndrome
• https://www.nlm.nih.gov/medlineplus/ency/article/000410.htm
• http://www.niddk.nih.gov/health-information/health-topics/endocrine/cushings-syndrome/Pages/fact-sheet.aspx