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Cushing syndrome due to adrenal tumor

Adrenal tumor - Cushing syndrome

 

Cushing 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.

Causes

 

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 tumors are rare. They can be noncancerous (benign) or cancerous (malignant).

Noncancerous tumors that can cause Cushing syndrome include:

  • Adrenal adenomas
  • Micronodular hyperplasia

Cancerous tumors that may cause Cushing syndrome include an adrenal carcinoma.

 

Symptoms

 

Most people with Cushing syndrome have:

  • Round, red, full face ( moon face )
  • 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 marks (1/2 inch or 1 centimeter or more wide), called striae , on the skin of the abdomen, thighs, and breasts
  • Thin skin with easy bruising

Muscle and bone changes include:

  • Backache, which occurs with routine activities
  • Bone pain or tenderness
  • Collection of fat between the shoulders and above the collar bone
  • Rib and spine fractures caused by thinning of the bones
  • Weak muscles, especially of the hips and shoulders

Women often have:

  • Excess hair growth on the face, neck, chest, abdomen, and thighs
  • Periods that become irregular or stop

Men may have:

  • Decreased or no desire for sex
  • Erection problems

Other symptoms that may occur include:

  • Mental changes, such as depression, anxiety, or changes in behavior
  • Fatigue
  • Headache
  • Increased thirst and urination

 

Exams and Tests

 

The health care provider will perform a physical exam and ask about your symptoms.

Tests to confirm Cushing syndrome:

  • 24-hour urine sample to measure cortisol and creatinine levels
  • Blood tests to check ACTH, cortisol, and potassium levels
  • Dexamethasone suppression test
  • Blood cortisol levels
  • Blood DHEA level
  • Saliva cortisol level

Tests to determine cause or complications include:

  • Abdominal CT
  • ACTH
  • Bone mineral density
  • Cholesterol
  • Fasting glucose

 

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 9 to 12 months.

If surgery is not possible, such as in cases of adrenal cancer, 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

 

Call 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 tumor-related Cushing syndrome.

 

 

Open References

References

Ferri FF. Cushing's disease and syndrome. In: Ferri FF, ed. Ferri's Clinical Advisor 2016 . Philadelphia, PA: Elsevier Mosby; 2016:385-386.

Nieman LK, Biller BM, Findling JW, et al. Treatment of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab . 2015;100:2807-2831. PMID: 26222757 www.ncbi.nlm.nih.gov/pubmed/26222757 .

Schneider DF, Mazeh H, Lubner SJ, Jaume JC, Chen H. Cancer of the endocrine system. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology . 5th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 71.

Stewart PM, Newell-Price JDC. The adrenal cortex. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 15.

 
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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 pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

    Endocrine glands

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  • Adrenal metastases, CT scan

    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

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  • Adrenal Tumor - CT

    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

    • Endocrine glands

      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 pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

      Endocrine glands

      illustration

    • Adrenal metastases, CT scan

      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

    • Adrenal Tumor - CT

      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

    A Closer Look

     

      Talking to your MD

       

        Self Care

         

          Tests for Cushing syndrome due to adrenal tumor

           
           

          Review Date: 10/28/2015

          Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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