Cushing Syndrome

Basics

Description

  • Cushing disease: Pituitary adenoma producing excess adrenocorticotropic hormone (ACTH)
  • Cushing syndrome: Excessive glucocorticoid effects
  • The incidence of Cushing syndrome due to endogenous overproduction of cortisol is 2–8 per million people annually

Risk Factors

Genetics

  • Multiple endocrine neoplasia (MEN) type I
  • Carney complex (pigmented lentigines, atrial myxoma, germ-cell tumors with Cushing disease)

Etiology

  • Most commonly exogenous administration of glucocorticoids either therapeutically or surreptitiously
  • Pituitary adenoma secreting ACTH
  • Adrenal production of cortisol from adenoma, carcinoma, or micronodular disease
  • Tumor-producing ectopic ACTH:
    • Small cell lung carcinoma:
      • Most common
    • Uterine cervical carcinoma
    • Islet cell tumor of pancreas:
      • MEN type I syndrome
    • Medullary thyroid cancer
    • Pheochromocytoma
    • Ganglioneuroma
    • Melanoma prostate carcinoma
    • Carcinoid tumor:
      • Lung
      • Pancreas
      • GI tract
      • Thymus
      • Ovary

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