5 Common Signs of Cushing’s Disease
Sudden weight gain that seems impossible to control. A face that looks rounder than before. Bruises appear without any clear cause. These changes might seem unrelated, but they could point to something deeper happening inside the body. Many people dismiss these warning signs as just part of aging or stress, but when they occur together, they may indicate Cushing’s disease, a serious hormonal disorder that requires medical attention.
Understanding Cushing’s Disease and Why It Matters
Cushing’s disease occurs when a noncancerous tumor on the pituitary gland causes excessive cortisol production. The condition primarily affects women of reproductive age, though it can impact males and females at any age.
This hormonal disorder most often affects adults between 20 and 50 years old, making it important for people in this age group to recognize the warning signs. While cortisol helps manage stress, blood pressure, and metabolism, too much of this hormone throws the body into overdrive, creating a cascade of visible and invisible symptoms.
The 5 Most Common Signs of Cushing’s Disease
1. Rapid Weight Gain with Unusual Fat Distribution
The most common symptom is sudden weight gain, with obesity usually showing central distribution. Unlike typical weight gain, Cushing’s disease triggers rapid weight gain, particularly in the trunk and face, while sparing the limbs.
This creates a distinctive pattern where fat accumulates around the midsection, face, and upper back. Common signs include growth of fat pads along the collarbone, on the back of the neck (called “buffalo hump”), and on the face (called “moon face”). Meanwhile, the arms and legs may actually become thinner, creating an unusual body shape that sets Cushing’s disease apart from regular weight gain.
2. Muscle Weakness Despite Normal Activity
Muscle weakness is one of the signs of cortisol excess that can develop initially. People with this condition often notice their arms and legs feeling weaker than usual, even when maintaining their normal exercise routine or daily activities.
This happens because excess cortisol breaks down muscle tissue and converts it into energy. The weakness typically affects muscles closest to the center of the body, such as the shoulders and hips, making everyday tasks like climbing stairs or lifting objects increasingly difficult. This symptom becomes especially concerning when combined with weight gain, as losing muscle while gaining fat creates a significant imbalance in body composition.
3. Distinctive Skin Changes and Bruising
The skin often tells the story of what’s happening inside the body. Key symptoms include thin skin with bruising and fragile skin that heals poorly. Purple stretch marks, called striae, appear on the skin of the abdomen, thighs, upper arms, and breasts, typically measuring half an inch or one centimeter or more in width.
These aren’t ordinary stretch marks from growth spurts or pregnancy. The striae associated with Cushing’s disease appear wider and have a distinctive reddish-purple color. Additionally, high cortisol levels reduce collagen production, making skin paper-thin and prone to bruising from the slightest bump. Cuts and scrapes take much longer to heal than normal, often leaving noticeable scars.
4. Facial Rounding and Color Changes
A round red face due to facial plethora is a characteristic sign. The face takes on a fuller, rounder appearance, sometimes described as having a moon-like shape. This facial change happens gradually, so people might not notice it themselves until they compare current photos to ones from several months earlier.
The redness or plethora comes from increased blood flow to facial tissues. Combined with the rounded appearance, these changes create a distinctive look that trained endocrinologists recognize as a potential indicator of excessive cortisol levels. Family members or close friends often notice these facial changes before the person experiencing them does.
5. Mood Changes and Mental Health Shifts
Mental changes such as depression, anxiety, moodiness, or behaving differently may develop. Cortisol directly affects neurotransmitters in the brain and disrupts the body’s stress response system, leading to emotional instability.
People might feel anxious without clear triggers, experience irritability over minor issues, or develop symptoms of depression. These mood changes often worsen gradually alongside physical symptoms. Because cortisol normally helps regulate mood and emotional responses, having too much creates an imbalance that affects mental well-being just as severely as physical health.
Additional Warning Signs to Watch For
Beyond the five main symptoms, several other signs may appear. Hypertension is likely to develop in patients who are more than 40 years of age. Additional signs include increased urination with accompanying increased thirst, persistent high blood pressure, and insulin resistance leading to high blood sugar.
Women may have excess hair on their face, neck, chest, abdomen, and thighs, with menstrual periods becoming irregular or stopping. Men may have decreased fertility with lowered interest in sex and erectile dysfunction. Children with Cushing’s syndrome tend to be obese and grow more slowly than other children.
Why Early Diagnosis Matters
Cushing syndrome can sometimes be difficult to diagnose because symptoms like fatigue and weight gain are common to many different diseases. Cushing syndrome is particularly difficult to diagnose because many symptoms can have other causes. This makes it easy to mistake the condition for other issues like metabolic syndrome or polycystic ovary syndrome.
However, early diagnosis makes a significant difference in treatment outcomes. When caught early, the condition causes less damage to organs and tissues. The combination of symptoms creates a clearer picture than any single sign alone, which is why tracking multiple symptoms over time helps healthcare providers identify the condition more accurately.
The Diagnostic Process
Healthcare providers use several specialized tests to confirm Cushing’s disease. These typically include 24-hour urine collection to measure cortisol levels, midnight salivary cortisol tests to check hormone levels when they should be lowest, and blood tests to assess ACTH and cortisol concentrations.
The best screening test for Cushing’s syndrome is a 24-hour urine collection with analysis for urinary free cortisol excretion. Additional testing may include low-dose and high-dose dexamethasone suppression tests, which help determine how the body responds to medications that should normally suppress cortisol production.
Imaging studies such as MRI scans can identify pituitary tumors or other abnormalities. The pituitary tumors in Cushing’s disease are usually microadenomas, which are 10 millimeters or less in diameter and generally do not cause symptoms by local mass effect.
Treatment Options and What to Expect
Treatment depends on what is causing Cushing’s syndrome and may include surgery to remove tumors or the adrenal glands, radiation, chemotherapy, or medicines. For most cases of Cushing’s disease caused by pituitary tumors, surgery to remove the tumor offers the best chance for a cure.
After surgical removal of pituitary tumors, patients often need temporary cortisol replacement therapy while the body readjusts to normal hormone production. In cases where surgery isn’t possible or doesn’t fully remove the tumor, radiation therapy provides an alternative treatment option. Medications that block cortisol production may help manage symptoms while awaiting other treatments or in cases where surgery and radiation aren’t suitable.
The Importance of Specialized Care
Managing Cushing’s disease requires expertise in endocrinology and hormonal disorders. The condition affects multiple body systems simultaneously, from metabolism and cardiovascular function to bone health and mental well-being. Comprehensive care involves not just treating the underlying cause but also managing complications like high blood pressure, diabetes, osteoporosis, and mood disorders.
Regular monitoring after treatment ensures the condition doesn’t return and helps identify any long-term effects that need ongoing management. Follow-up care typically includes periodic hormone level testing, imaging studies, and assessment of bone density and cardiovascular health.
Take Action for Better Health
Recognizing the signs of Cushing’s disease represents the first step toward getting proper treatment. When multiple symptoms appear together, especially the combination of central weight gain, muscle weakness, distinctive skin changes, facial rounding, and mood shifts, seeking evaluation from an endocrinology specialist becomes crucial.
Living with undiagnosed Cushing’s disease can lead to serious complications, including heart disease, diabetes, bone fractures, and increased infection risk. However, with proper diagnosis and treatment, most people experience significant improvement in symptoms and quality of life.
Ready to take control of your health? Dr. Kehinde Folawewo, MD, leads Hilltop Internal Medicine and Endocrinology with expertise that makes all the difference. As a double board-certified endocrinologist who completed both her Internal Medicine residency and Endocrinology fellowship at Howard University Hospital, Dr. Folawewo brings extensive experience in managing complex hormonal disorders like Cushing’s disease.
Her practice specializes in comprehensive endocrine care, offering thorough evaluations, advanced diagnostic testing, and personalized treatment plans tailored to each patient’s unique needs. Dr. Folawewo is committed to evidence-based medicine and takes the time to listen, explain, and ensure patients feel heard and respected throughout their care journey.
Located conveniently in Oxon Hill, Maryland, Dr. Folawewo offers both in-person visits and telemedicine consultations to accommodate busy schedules. With flexible appointment options and a focus on providing the same care she would want for herself, patients receive compassionate, expert attention for even the most complex endocrine conditions.
Don’t let concerning symptoms go unchecked. Schedule a consultation with Dr. Folawewo today at (301) 567-9570 to get the answers and specialized care needed for optimal hormonal health and improved quality of life.
