Cushing syndrome due to adrenal tumor
Adrenal tumor - Cushing syndrome; Cushing's syndrome due to adrenal tumorCushing 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.
Cushing syndrome
Cushing syndrome is a disorder that occurs when your body has a high level of the hormone cortisol.
Read Article Now Book Mark ArticleCauses
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 glands
The adrenal glands are two small triangle-shaped glands in the upper abdomen. One gland is located on top of each kidney.
Read Article Now Book Mark ArticleAdrenal 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
Hyperplasia
Hyperplasia is increased cell production in a normal tissue or organ. Hyperplasia may be a sign of abnormal or precancerous changes. This is called...
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Cancerous tumors that may cause Cushing syndrome include an adrenal carcinoma. This is a rare tumor, but it usually makes excess cortisol.
Symptoms
Most people with Cushing syndrome have:
- Round, red, full face (moon face)
Moon face
Facial swelling is the buildup of fluid in the tissues of the face. Swelling may also affect the neck and upper arms.
Read Article Now Book Mark Article - 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
Striae
Stretch marks are irregular areas of skin that look like bands, stripes, or lines. Stretch marks are seen when a person grows or gains weight rapidl...
Read Article Now Book Mark Article - Thin skin with easy bruising
Muscle and bone changes include:
- Backache, which occurs with routine activities
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Bone pain or tenderness
Bone pain or tenderness
Bone pain or tenderness is aching or other discomfort in one or more bones.
Read Article Now Book Mark Article - Collection of fat between the shoulders and above the collar bone
- Rib and spine fractures caused by thinning of the bones
Thinning of the bones
Osteoporosis is a disease in which bones become fragile and more likely to break (fracture).
Read Article Now Book Mark Article - 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)
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Erection problems
Erection problems
An erection problem occurs when a man cannot get or keep an erection that is firm enough for intercourse. You may not be able to get an erection at ...
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Other symptoms that may occur include:
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Mental changes, such as depression, anxiety, or changes in behavior
Depression
Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for shor...
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Fatigue
Fatigue
Fatigue is a feeling of weariness, tiredness, or lack of energy.
Read Article Now Book Mark Article - Headache
- Increased thirst and urination
Exams and Tests
Your health care provider will perform a physical exam and ask about your symptoms.
Tests to confirm Cushing syndrome:
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24-hour urine sample to measure cortisol and creatinine levels
24-hour urine sample
The urine 24-hour volume test measures the amount of urine produced in a day. The amounts of creatinine, protein, and other chemicals released into ...
Read Article Now Book Mark ArticleCortisol
The cortisol urine test measures the level of cortisol in the urine. Cortisol is a glucocorticoid (steroid) hormone produced by the adrenal gland. C...
Read Article Now Book Mark ArticleCreatinine
The creatinine urine test measures the amount of creatinine in urine. This test is done to see how well your kidneys are working. Creatinine in the ...
Read Article Now Book Mark Article - Blood tests to check ACTH (adrenocorticotropic hormone), cortisol, and potassium levels
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Dexamethasone suppression test
Dexamethasone suppression test
The dexamethasone suppression test measures whether cortisol secretion by the adrenal gland can be suppressed. It can also help assess the reason fo...
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Blood cortisol levels
Blood cortisol levels
The cortisol blood test measures the level of cortisol in the blood. Cortisol is a steroid (glucocorticoid or corticosteroid) hormone produced by th...
Read Article Now Book Mark Article - Blood DHEA level
- Saliva cortisol level
Tests to determine cause or complications include:
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Abdominal CT -- usually with and without IV contrast
Abdominal CT
An abdominal CT scan is an imaging method. This test uses x-rays to create cross-sectional pictures of the belly area. CT stands for computed tomog...
Read Article Now Book Mark Article - ACTH
- Bone mineral density
- Cholesterol
- Fasting glucose
In some cases, you need a special test called adrenal vein sampling to determine which adrenal gland is making too much cortisol and causing Cushing syndrome.
Treatment
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 3 to 12 months.
If surgery is not possible, such as in cases of adrenal cancer that has spread (metastasis), medicines can be used to stop the release of cortisol.
Outlook (Prognosis)
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.
Possible Complications
Cancerous adrenal tumors can spread to the liver or lungs.
When to Contact a Medical Professional
Contact your provider if you develop any symptoms of Cushing syndrome.
Prevention
Appropriate treatment of adrenal tumors may reduce the risk of complications in some people with adrenal tumor-related Cushing syndrome.
References
Asban A, Patel AJ, Reddy S, Wang T, Balentine CJ, Chen H. Cancer of the endocrine system. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 68.
Fragaso MCBV, Berthon A, Bertherat J. Adrenocorticotropic hormone–independent Cushing syndrome. In: Robertson RP, ed. DeGroot's Endocrinology. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 97.
Newell-Price JDC, Auchus RJ. The adrenal cortex. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 15.
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 pubmed.ncbi.nlm.nih.gov/26222757/.
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Endocrine glands - illustration
Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).
Endocrine glands
illustration
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Adrenal metastases - CT scan - illustration
This CT scan of the upper abdomen shows an adrenal metastasis (spreading of a tumor to the adrenal gland, above the kidney) in a person with lung cancer.
Adrenal metastases - CT scan
illustration
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Adrenal Tumor - CT - illustration
CT scan of the upper abdomen in a person with a right adrenal mass. The adrenal glands are located above the kidneys.
Adrenal Tumor - CT
illustration
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Endocrine glands - illustration
Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).
Endocrine glands
illustration
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Adrenal metastases - CT scan - illustration
This CT scan of the upper abdomen shows an adrenal metastasis (spreading of a tumor to the adrenal gland, above the kidney) in a person with lung cancer.
Adrenal metastases - CT scan
illustration
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Adrenal Tumor - CT - illustration
CT scan of the upper abdomen in a person with a right adrenal mass. The adrenal glands are located above the kidneys.
Adrenal Tumor - CT
illustration
Review Date: 5/12/2023
Reviewed By: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.