Cushing's Syndrome
Cushing's syndrome results from prolonged exposure to excess cortisol, either from an endogenous source (pituitary adenoma causing Cushing's disease, adrenal tumor, or ectopic ACTH) or, more commonly, from exogenous corticosteroid medications. The excess cortisol drives a distinctive cluster of metabolic, cardiovascular, and musculoskeletal complications.
When to Book
Book a visit if symptoms are new, persistent, getting worse, or affecting daily life. Early evaluation often prevents complications.
Symptoms
Progressive central weight gain with a relatively thin face and extremities, broad purple stretch marks (striae), easy bruising, muscle weakness especially in the proximal thighs, hypertension, high blood sugar, fatigue, depression, poor wound healing, and — in women — menstrual irregularity and hirsutism. A 'buffalo hump' fat pad at the posterior neck and a rounded 'moon face' are classic.
Causes & Risk Factors
Pituitary ACTH-secreting adenoma (Cushing's disease) causes 70% of endogenous cases. Adrenal adenoma or carcinoma, ectopic ACTH from a lung or pancreatic tumor account for the rest. Iatrogenic Cushing's from chronic steroid use is the most common overall cause.
How We Evaluate
Screening tests — 24-hour urinary free cortisol, late-night salivary cortisol (two measurements), and 1 mg overnight dexamethasone suppression test — establish hypercortisolism. ACTH level differentiates pituitary/ectopic (ACTH-dependent) from adrenal (ACTH-independent) causes. MRI of the pituitary and CT of the adrenal glands are the primary imaging modalities.
Treatment Options
Surgical resection is first-line for pituitary adenoma (transsphenoidal surgery) and adrenal tumors. Radiation therapy and medical management (ketoconazole, metyrapone, osilodrostat) are used when surgery fails or is not feasible. Ectopic ACTH requires treatment of the primary tumor. Gradual steroid taper manages iatrogenic Cushing's.
When It Is Urgent
Severe hypertension, uncontrolled diabetes, or cardiovascular events related to Cushing's may require emergency management. Adrenal crisis can develop after treatment as the suppressed HPA axis recovers.
Frequently Asked Questions
Do I need a referral to see an endocrinology provider?
No referral is needed at Nomi Beach Health. You can book directly with our team for hormone, thyroid, metabolic, or weight-management concerns.
How long does it take to see results from treatment?
Timeline depends on the condition. Thyroid medication often improves symptoms within four to eight weeks. Weight-loss interventions show measurable changes in four to twelve weeks. Hormone therapy timelines vary by the specific condition and individual response.
Will I need labs before my first visit?
You can come in without prior labs — we order whatever is appropriate during or after your visit. If you have recent results, bring them so we can start the conversation right away.
Are these conditions managed long-term or treated once?
Most endocrine and metabolic conditions require ongoing management rather than a single treatment. We build a follow-up schedule around your specific diagnosis and goals.
Can I be seen for weight loss even if I do not have a hormone diagnosis?
Yes. We evaluate weight holistically — including metabolic markers, lifestyle factors, and, when appropriate, medication options such as GLP-1 agonists.
Get a Clear Plan for Cushing's Syndrome
Our endocrinology team evaluates you as an individual and builds a treatment plan that fits your life — not a template.