Health Encyclopedia

Cushing syndrome due to adrenal tumor

Definition

Cushing syndrome due to adrenal tumor is an endocrine system disorder that occurs when there is a tumor of the adrenal gland releasing excess amounts of the hormone cortisol.

Alternative Names

Adrenal tumor - Cushing syndrome

Causes, incidence, and risk factors

Cushing syndrome is caused by constant, high levels of the steroid hormone cortisol. A tumor on one of the adrenal glands causes about 15% of all cases of Cushing syndrome. Adrenal tumors release cortisol.

Adrenal tumors may be non-cancerous (benign) or cancerous (malignant).

Non-cancerous tumors that may cause Cushing syndrome include:

Adrenal adenomas
Micronodular hyperplasia

Cancerous tumors that may cause Cushing syndrome include:

Adrenal carcinomas

Adrenal tumors are rare. They may develop in anyone at any age, but are much more common in adults. They are found in women more often than men.

Symptoms

Breast development and impotence in men
Depression
Headache
High blood pressure
Round, red, and full face (moon face)
Skin changes
- Acne or other skin infections
- Easy bruising
- Purple streaks on the skin of the abdomen, thighs, and breasts
- Thinning of the skin
Stopping of menstruation in women
Weight gain
- Abdomen that sticks out and thin arms and legs
- Collection of fat between the shoulders (buffalo hump)
Weakened bones (osteoporosis)
Weakness (often noticed when trying to stand up or to raise hand above head)

Patients with a cancerous adrenal tumor may also have symptoms of higher-than-normal male hormone (androgen) levels, including:

Acne
Excess hair in unusual parts of the body (in women)
Scalp hair loss

Signs and tests

Tests to confirm Cushing syndrome:

24-hour urine sample to measure the following:
- Urine cortisol
- Urine creatinine
Dexamethasone suppression test
Serum cortisol levels

Tests to determine cause:

Abdominal CT
ACTH
High-dose dexamethasone suppression test

Other findings may include:

High cholesterol
High fasting glucose
Low bone density, seen by dual x-ray absorptiometry (DEXA)
Low serum potassium

Treatment

Cushing syndrome due to an adrenal tumor is treated with surgery to remove the tumor and often the entire adrenal gland.

Glucocorticoid replacement treatment is usually needed until the other adrenal gland recovers from surgery. You may need this treatment for 9 - 12 months.

If surgery is not possible (such as in cases of adrenal cancer), medicines can be used to stop the release of cortisol. These include:

Aminoglutethimide
Ketoconazole
Mifepristone
Mitotane

Radiation therapy usually does not work for cancerous adrenal tumors and is not appropriate for non-cancerous tumors.

Expectations (prognosis)

Patients with an adrenal tumor who have surgery have an excellent outlook. Surgery success rates are very high with this type of tumor.

For adrenal cancer, surgery is sometimes not possible. When surgery is performed, it does not always cure the cancer.

Complications

Cancerous adrenal tumors can spread to the liver or lungs.

Calling your health care provider

Call your health care provider if you develop any symptoms of Cushing syndrome.

Prevention

Appropriate treatment of adrenal tumors may reduce the risk of complications in some patients with tumor-related Cushing syndrome.

References

Stewart PM. The Adrenal Cortex. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR. Kronenberg: Williams Textbook of Endocrinology. 11th ed. Saunders Elsevier; 2008:chap 14.

Review Date:3/18/2008
Reviewed By:Elizabeth H. Holt, MD, PhD, Assistant Professor of Medicine, Section of Endocrinology and Metabolism, Yale University. Review provided by VeriMed Healthcare Network. Also reviewed byDavid Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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