Cushing’s Disease vs Cushing’s Syndrome: Understanding the Difference
Cushing’s Syndrome is a rare hormonal disorder caused by abnormally high levels of cortisol, a steroid hormone produced by the adrenal glands. Cortisol is important for managing stress, regulating blood pressure, controlling inflammation, and many other body functions. However, when cortisol levels become excessively elevated, serious health problems develop. Cushing’s Disease is a specific type of Cushing’s Syndrome. Cushing’s Disease occurs when a pituitary adenoma, a noncancerous tumor in the pituitary gland, produces excessive amounts of adrenocorticotropic hormone, or ACTH. ACTH stimulates the adrenal glands to produce cortisol. When the pituitary tumor produces too much ACTH, the adrenal glands produce excessive cortisol. Understanding the difference between Cushing’s Syndrome and Cushing’s Disease is important because the terms are often confused. Cushing’s Syndrome is the broader term for any condition causing elevated cortisol levels. Cushing’s Disease is a specific cause of Cushing’s Syndrome, where a pituitary adenoma produces excess ACTH. Cushing’s Syndrome affects approximately one to two people per million worldwide, making it a rare disorder. Cushing’s Disease accounts for about seventy-five percent of cases of Cushing’s Syndrome. Other causes of Cushing’s Syndrome include adrenal adenomas that directly produce cortisol, ectopic ACTH production from tumors outside the pituitary and adrenal glands, and rarely, familial Cushing’s Syndrome from genetic mutations. The condition was first described by neurosurgeon Harvey Cushing in 1912, and the eponym has been retained to honor his recognition of this condition. Cushing’s Syndrome is a serious disorder that causes significant morbidity and mortality if left untreated. The prolonged exposure to excessive cortisol damages multiple organ systems. Early recognition and diagnosis are crucial for starting appropriate treatment. With proper treatment, cortisol levels can be controlled and many complications can be prevented or reversed. However, some permanent effects from prolonged exposure to excess cortisol may not completely resolve. Understanding the differences between Cushing’s Syndrome and Cushing’s Disease helps guide appropriate diagnosis and treatment decisions.
What is the Difference Between Cushing’s Disease and Cushing’s Syndrome?
The key difference between Cushing’s Disease and Cushing’s Syndrome is the underlying cause of elevated cortisol levels. Cushing’s Syndrome is the general term for any condition that causes elevated cortisol levels, regardless of the cause. Cushing’s Disease is a specific type of Cushing’s Syndrome caused by a pituitary adenoma producing excessive ACTH. All people with Cushing’s Disease have Cushing’s Syndrome, but not all people with Cushing’s Syndrome have Cushing’s Disease. To understand this relationship, think of Cushing’s Syndrome as an umbrella term for any condition causing excess cortisol, and Cushing’s Disease as one specific cause under that umbrella. Cushing’s Syndrome has multiple causes. ACTH-dependent Cushing’s Syndrome results from excess ACTH stimulating cortisol production. Cushing’s Disease is the most common ACTH-dependent cause, accounting for about seventy-five percent of ACTH-dependent cases. Ectopic ACTH syndrome accounts for about twenty-five percent of ACTH-dependent cases, where tumors outside the pituitary, usually in the lungs or pancreas, produce ACTH. ACTH-independent Cushing’s Syndrome results from the adrenal glands producing excess cortisol independently. Adrenal adenomas, benign tumors of the adrenal gland, directly produce cortisol without ACTH stimulation. Adrenocortical carcinoma, a rare cancer of the adrenal gland, produces cortisol. Primary pigmented nodular adrenocortical disease, or PPNAD, is a rare genetic form of ACTH-independent disease. In Cushing’s Disease specifically, a pituitary adenoma produces ACTH. The tumor is usually small and stays within the pituitary gland. Cushing’s Disease accounts for about sixty to eighty percent of Cushing’s Syndrome cases overall. Cushing’s Disease is about four times more common in women than men. The disease typically develops in middle-aged adults but can occur at any age. The diagnosis and treatment differ depending on whether someone has Cushing’s Disease or another cause of Cushing’s Syndrome. Diagnostic tests help determine the source of excess cortisol. Treatment differs based on the cause. Cushing’s Disease is treated with pituitary surgery or other pituitary-directed therapies. ACTH-independent disease is treated with adrenal surgery. Ectopic ACTH syndrome requires identification and treatment of the ectopic tumor. Understanding which type of Cushing’s Syndrome is present is essential for appropriate treatment decisions.
How Does Excess Cortisol Cause Cushing’s Syndrome?
To understand how excess cortisol causes Cushing’s Syndrome, we need to learn about the normal cortisol control system. The hypothalamus is part of the brain that controls many hormonal systems. The pituitary gland is a small gland located at the base of the brain below the hypothalamus. The adrenal glands are small glands located on top of the kidneys. Together, these three glands form the hypothalamic-pituitary-adrenal, or HPA, axis. In this normal system, the hypothalamus produces corticotropin-releasing hormone, or CRH. CRH stimulates the pituitary gland to produce ACTH. ACTH stimulates the adrenal glands to produce cortisol. When cortisol levels become high enough, they send a feedback signal to the hypothalamus and pituitary telling them to stop producing CRH and ACTH. This negative feedback system normally keeps cortisol levels in a healthy range. In Cushing’s Disease, a pituitary adenoma produces ACTH excessively. The tumor cells are not responsive to the normal feedback signal from cortisol. They continue producing ACTH despite high cortisol levels. The continued ACTH stimulation causes the adrenal glands to produce excessive cortisol. The excess cortisol is the problem that causes all the symptoms and complications of Cushing’s Disease. In ectopic ACTH syndrome, a tumor outside the pituitary, usually in the lungs or pancreas, produces ACTH. Again, the tumor cells are not responsive to normal feedback. They produce excessive ACTH which stimulates excessive cortisol production. In ACTH-independent Cushing’s Syndrome, the adrenal glands themselves produce excessive cortisol directly. This occurs from adrenal adenomas or adenocarcinomas. The tumor cells produce cortisol without any ACTH stimulation. The excessive cortisol, regardless of its cause, causes widespread effects throughout the body. Cortisol affects metabolism, causing central obesity and insulin resistance. Cortisol suppresses immune function, increasing infection risk. Cortisol weakens bones and muscles. Cortisol increases blood pressure. Cortisol affects mood and cognition. Prolonged exposure to excess cortisol causes multiple complications. The severity of complications depends on how elevated cortisol levels are and how long the person has been exposed to excess cortisol. Early treatment to lower cortisol levels is important to prevent irreversible complications.
What Are the Main Symptoms and Signs of Cushing’s Syndrome?
Cushing’s Syndrome causes a wide variety of physical, metabolic, and psychological symptoms due to the effects of excessive cortisol on body systems. Central obesity with fat redistribution is very characteristic. Abnormal fat accumulation occurs in the face, causing a round appearance called moon facies. Fat accumulates between the shoulders, causing a hump-like appearance called buffalo hump. The trunk becomes obese while the arms and legs remain relatively thin. This unusual fat distribution pattern is distinctive. Skin changes are very common. Purple stretch marks develop on the abdomen, thighs, and other areas. Skin becomes thin and fragile, bruising easily. Acne and skin infections are common. Hyperpigmentation, or darkening of the skin, may develop. Easy bruising is characteristic. Minor bumps cause visible bruising. Bruises appear without remembered injury. The bruising results from fragile blood vessels from prolonged cortisol exposure. Muscle weakness is very characteristic of Cushing’s Syndrome. Proximal muscle weakness affects muscles closest to the center of the body like hip and shoulder muscles. Weakness makes climbing stairs and getting up from a chair difficult. Weight gain occurs despite possible loss of appetite. The centralized obesity with fat redistribution gives a characteristic appearance. Facial appearance changes with moon facies and fat accumulation. Hair growth changes with increased facial hair in women. Acne develops or worsens. High blood pressure develops in about eighty percent of people with Cushing’s Syndrome. The hypertension results from multiple mechanisms including direct cortisol effects and metabolic abnormalities. Diabetes develops in about fifty percent of people with Cushing’s Syndrome. Cortisol opposes insulin action, causing insulin resistance. Glucose intolerance develops and progresses to diabetes. Mood and cognitive changes are very common. Depression occurs in about eighty percent of people with Cushing’s Syndrome. Anxiety, irritability, and emotional lability are common. Cognitive dysfunction, or “brain fog,” affects memory and concentration. Psychosis can occur in severe cases. Amenorrhea, or loss of menstrual periods, occurs in women due to suppression of reproductive hormones. Decreased libido occurs in both men and women. Sexual dysfunction affects intimate relationships. Osteoporosis develops due to cortisol’s effects on bone metabolism. Bone density decreases. Fracture risk increases dramatically. Vertebral fractures are common. Fatigue and weakness are profound and limit activity. The fatigue is different from normal tiredness and often profoundly impacts quality of life. Sleep disturbance is common. Insomnia or abnormal sleep patterns develop. Polyuria and polydipsia, excessive urination and thirst, result from glucose elevations and direct cortisol effects. Hirsutism, or excess hair growth, develops in women from androgen effects. Acanthosis nigricans, dark velvety skin thickening, may develop. Headaches and visual disturbances may occur if the pituitary tumor is causing mass effect on nearby structures.
How is Cushing’s Syndrome Diagnosed?
Cushing’s Syndrome is difficult to diagnose because symptoms are nonspecific and mimic other conditions. Diagnosis requires a combination of clinical suspicion and specific biochemical tests. Clinical history of symptoms suggesting Cushing’s Syndrome is important. Progressive weight gain with central obesity, proximal weakness, purple stretch marks, easy bruising, hypertension, and mood changes should raise suspicion. Physical examination reveals characteristic findings. Central obesity with fat redistribution. Moon facies and buffalo hump. Purple stretch marks. Easy bruising. Proximal muscle weakness. Hypertension. Twenty-four-hour urine cortisol collection is an important screening test. Cortisol is excreted in urine. A twenty-four-hour collection measures total urinary cortisol. Elevated urinary cortisol suggests Cushing’s Syndrome. Two elevated twenty-four-hour urinary cortisol measurements help confirm the diagnosis. Late-night salivary cortisol measurement is a convenient screening test. Cortisol normally drops at night. In Cushing’s Syndrome, cortisol remains elevated at night. Elevated late-night salivary cortisol suggests Cushing’s Syndrome. Dexamethasone suppression test is done to confirm Cushing’s Syndrome. Dexamethasone is a synthetic corticosteroid. In healthy people, dexamethasone suppresses ACTH and cortisol. In Cushing’s Syndrome, cortisol fails to suppress. Failure of cortisol to suppress after dexamethasone is diagnostic. Once Cushing’s Syndrome is confirmed, determining the cause is necessary. Plasma ACTH level is measured. High ACTH suggests ACTH-dependent disease like Cushing’s Disease or ectopic ACTH syndrome. Low ACTH suggests ACTH-independent disease from adrenal pathology. Pituitary MRI is done if ACTH-dependent disease is suspected. The MRI can visualize pituitary adenomas causing Cushing’s Disease. Small adenomas may not be visible on MRI. Inferior petrosal sinus sampling is a specialized test for ACTH-dependent disease. Catheters are placed in veins draining the pituitary. ACTH is measured. High ACTH in the petrosal sinus compared to peripheral blood suggests Cushing’s Disease. This helps distinguish Cushing’s Disease from ectopic ACTH syndrome. Adrenal imaging with CT or MRI is done if ACTH-independent disease is suspected. Adrenal adenomas can usually be visualized. Chest imaging is done if ectopic ACTH syndrome is suspected. Lung tumors are the most common source of ectopic ACTH. Early diagnosis allows treatment to be started before serious complications develop.
What Health Complications Do People with Cushing’s Syndrome Face?
People with Cushing’s Syndrome face serious health complications due to prolonged exposure to excess cortisol. The severity and extent of complications depend on how elevated cortisol is and how long the person has had the disease. Type 2 diabetes develops in about fifty percent of people with Cushing’s Syndrome. Cortisol opposes insulin action causing insulin resistance. Blood glucose elevations develop and progress to diabetes. Diabetic complications including kidney disease, neuropathy, and retinopathy can develop. Hypertension develops in about eighty percent of people with Cushing’s Syndrome. Cortisol increases blood pressure through multiple mechanisms. Elevated blood pressure increases risk of heart disease and stroke. Hypertensive crises can occur in severe cases. Cardiovascular disease is significantly increased. Coronary artery disease accelerates from the combined effects of hypertension, diabetes, and dyslipidemia. Heart failure can develop from years of hypertension and left ventricular strain. Cardiac arrhythmias develop from enlarged heart and electrolyte abnormalities. Sudden cardiac death can occur. Cardiovascular disease is a major cause of death in Cushing’s Syndrome. Osteoporosis is very common and severe in Cushing’s Syndrome. Cortisol accelerates bone loss. Bone density decreases dramatically. Fracture risk increases dramatically. Vertebral fractures occur frequently and may be multiple. Hip fractures increase mortality. Spinal deformities develop from multiple vertebral fractures. Severe back pain develops from compression fractures. Muscle weakness and wasting develop from cortisol’s catabolic effects. Proximal muscle weakness makes mobility difficult. Muscle loss accelerates. Weakness contributes to falls and fracture risk. Psychiatric complications are severe. Depression affects about eighty percent of people with Cushing’s Syndrome. Psychosis can occur with paranoia and hallucinations. Cognitive dysfunction impairs memory and concentration. Dementia-like changes can develop. Suicide risk is increased. Immune suppression increases infection risk. Opportunistic infections can occur. Recurrent infections are common. Severe infections that would normally be minor become serious. Increased cancer risk occurs. Colorectal cancer and other cancers have increased incidence. Adrenocortical carcinoma risk increases in some forms. Renal complications develop from hypertension and diabetes. Kidney disease and chronic kidney disease develop. Protein in urine indicates kidney damage. Kidney failure may develop requiring dialysis. Hypokalemia, or low potassium, develops particularly in ectopic ACTH syndrome. Low potassium causes muscle weakness and cardiac arrhythmias. Hypokalemia can be life-threatening. Reproductive complications develop. Amenorrhea and infertility occur in women. Erectile dysfunction occurs in men. Growth retardation occurs in children with Cushing’s Syndrome. Shortened stature results from inhibition of growth hormone. Behavioral and learning problems develop in children. Untreated Cushing’s Syndrome is progressive and leads to serious morbidity and mortality. Early treatment is crucial to prevent irreversible complications.
What Treatments Help People with Cushing’s Syndrome and Cushing’s Disease?
Treatment for Cushing’s Syndrome depends on the underlying cause. Different types require different treatment approaches. The goal of treatment is to normalize cortisol levels and prevent or reverse complications. Cushing’s Disease treatment focuses on removing or controlling the pituitary adenoma. Transsphenoidal pituitary surgery is the first-line treatment. The tumor is removed through an opening in the sphenoid bone at the base of the skull. Successful surgery normalizes ACTH and cortisol levels. Success rate depends on tumor size. Smaller tumors have higher cure rates, sometimes exceeding ninety percent. Larger or invasive tumors have lower cure rates. Recurrence can occur even after initially successful surgery. Medical therapy may be used before surgery to lower cortisol levels. Cortisol-lowering medications including ketoconazole, mitotane, and metyrapone inhibit cortisol synthesis. These medications quickly lower cortisol levels. However, they don’t treat the underlying tumor. Radiotherapy may be used if surgery is unsuccessful or not feasible. Conventional radiotherapy uses multiple sessions directed at the pituitary. Gamma knife stereotactic radiotherapy delivers focused high-dose radiation in fewer sessions. Radiotherapy is slower acting than surgery but can eventually lower cortisol levels. Radiation carries some risk of pituitary dysfunction. Pasireotide is a somatostatin analog that suppresses ACTH in some cases of Cushing’s Disease. This medication can control disease in patients not cured by surgery. Dopamine agonists like cabergoline suppress ACTH in some cases. ACTH-independent Cushing’s Syndrome from adrenal pathology is treated with adrenal surgery. Adrenalectomy, surgical removal of the affected adrenal gland, is curative for adrenal adenomas. Cortisol levels normalize after removal of the tumor-producing adrenal. Bilateral adrenalectomy is sometimes done for severe disease but results in permanent adrenal insufficiency requiring lifelong hormone replacement. Ectopic ACTH syndrome requires identification and treatment of the ectopic tumor. If the ectopic tumor can be identified and removed, ectopic ACTH syndrome can be cured. Medical management with cortisol-lowering medications controls cortisol levels before tumor removal. Management of complications is important. Diabetes is treated with antidiabetic medications and lifestyle modifications. Hypertension is managed with antihypertensive medications. Bone loss is treated with bisphosphonates and calcium/vitamin D supplementation. Depression is treated with antidepressants and psychotherapy. Psychiatric complications require mental health care. Potassium replacement corrects hypokalemia. Regular monitoring of cortisol levels and clinical response guides treatment adjustments. The goal is to normalize cortisol levels and maintain normal hormone levels long-term. Successful treatment and cortisol normalization allows reversal or improvement of many complications.
Living with Cushing’s Syndrome and Cushing’s Disease
Living with Cushing’s Syndrome and Cushing’s Disease is challenging due to the multiple symptoms, physical changes, metabolic complications, and need for ongoing medical management. For people newly diagnosed with Cushing’s Syndrome, the diagnosis can be overwhelming. Learning about a serious hormonal disorder affecting multiple body systems is frightening. However, understanding that treatment is available and cortisol levels can be controlled offers hope. Patient education about the condition, treatment options, and expected course helps people understand their condition and participate in treatment decisions. Physical appearance changes significantly affect body image and self-esteem. The progressive weight gain with central obesity, moon facies, buffalo hump, and purple stretch marks can cause embarrassment. People may feel unrecognizable compared to their previous appearance. The combination of physical changes and psychiatric symptoms can severely impact emotional wellbeing. Psychological support including counseling helps address emotional impacts. Work and activity limitations result from muscle weakness and fatigue. Many people cannot continue full-time work due to severe fatigue and weakness. Disability support may be necessary. Simple daily tasks become difficult. Climbing stairs is impossible. Getting up from sitting is difficult. Basic self-care may require assistance. School-age children with Cushing’s Syndrome experience growth retardation and developmental delays. Falling behind peers in school and not growing normally cause emotional distress. Educational accommodations may be necessary. Emotional and behavioral problems in children require psychological support. Mental health challenges are very common. Depression affects about eighty percent of people with Cushing’s Syndrome. Anxiety and mood instability occur. Cognitive dysfunction affects concentration and memory. Psychosis can develop in severe cases. Suicidal ideation occurs in some. Mental health services including antidepressants and psychotherapy are essential. Psychiatric monitoring is important as cortisol levels may improve rapidly with treatment, sometimes leading to sudden improvement in mood and cognition. Bone health becomes a focus. Osteoporosis requires aggressive management with bisphosphonates, calcium, and vitamin D. Weight-bearing exercise within tolerated limits helps maintain bone health. Fall prevention is crucial to prevent fractures. Recovery from pathological fractures takes longer than normal. Diabetes management becomes a major part of life for those developing diabetes. Blood glucose monitoring, dietary modifications, and antidiabetic medications are necessary. Managing hypertension requires blood pressure monitoring and antihypertensive medications. Dietary sodium restriction helps. Regular monitoring of blood pressure guides medication adjustments. Cardiac monitoring assesses heart function and detects cardiac problems early. Treatment recovery varies depending on treatment type. Surgery recovery takes several weeks with gradual improvement. Medical therapy takes weeks to months for full effect. Radiotherapy effect develops gradually over months. During treatment and recovery, cortisol normalization often leads to rapid improvement in mood and energy. People report feeling dramatically better as cortisol levels drop. Permanent effects like osteoporosis and some cosmetic changes may persist even after cortisol normalization. Accepting permanent changes while celebrating successful disease control helps optimize quality of life. Long-term follow-up is necessary to monitor for treatment complications and disease recurrence. With appropriate treatment to normalize cortisol levels, good management of complications, bone health preservation, mental health support, and family support, many people with Cushing’s Syndrome achieve good long-term outcomes and quality of life despite the severity of the disease.
Frequently Asked Questions About Cushing’s Syndrome and Cushing’s Disease
FAQ 1: Is Cushing’s Disease hereditary? Most cases of Cushing’s Disease are not hereditary. Cushing’s Disease results from a pituitary adenoma that develops spontaneously during a person’s lifetime. The adenoma is not inherited. However, in rare cases, Cushing’s Disease can be part of hereditary syndromes. Multiple Endocrine Neoplasia type 1, or MEN1, is a hereditary condition where people develop multiple tumors including pituitary adenomas. People with MEN1 may develop ACTH-secreting adenomas causing Cushing’s Disease. Carney complex is another hereditary syndrome that can include primary pigmented nodular adrenocortical disease. If you have Cushing’s Disease and a family history of endocrine tumors, genetic testing for hereditary syndromes may be appropriate. Genetic counseling can help determine if genetic testing is recommended. Most family members of people with sporadic Cushing’s Disease do not have increased risk.
FAQ 2: Can Cushing’s Syndrome be cured? Cushing’s Syndrome can often be cured by treating the underlying cause. For Cushing’s Disease, surgical removal of the pituitary adenoma can be curative if the entire tumor is removed. Success rates depend on tumor size and the surgeon’s expertise. For ACTH-independent disease, surgical removal of the cortisol-producing adrenal tumor is curative. For ectopic ACTH syndrome, removal of the ectopic tumor can be curative. However, if the tumor cannot be completely removed, medical therapy is necessary to control cortisol levels. Some cases require long-term medical management if curative treatment is not possible. With proper treatment, even if not curative, cortisol levels can be normalized and complications prevented. Early diagnosis and treatment improve the chances of achieving cure or excellent disease control.
FAQ 3: How quickly does Cushing’s Syndrome develop? Cushing’s Syndrome develops relatively slowly. The pituitary adenomas in Cushing’s Disease typically grow very slowly over months to years before symptoms become apparent. The physical changes develop gradually over months to years. People often don’t realize how much they’ve changed because the development is so gradual. Family members may not notice the gradual changes. This slow development contributes to diagnostic delays. However, the complications from prolonged cortisol exposure can be severe and progressive. Early recognition and treatment are important to prevent irreversible complications. The longer untreated Cushing’s Syndrome persists, the greater the risk of serious complications.
FAQ 4: What is the life expectancy for someone with Cushing’s Syndrome? Life expectancy is reduced in people with untreated Cushing’s Syndrome due to cardiovascular complications, diabetes, infections, and other disease effects. However, with appropriate treatment that normalizes cortisol levels, life expectancy improves substantially. Studies show that people with adequately treated Cushing’s Syndrome have survival approaching that of the general population. The key to good long-term outcomes is early diagnosis, prompt treatment to normalize cortisol, and ongoing management of complications including diabetes, hypertension, and bone health. Cardiovascular complications are the leading cause of excess mortality in Cushing’s Syndrome. With proper prevention and management of these complications, survival improves dramatically.
FAQ 5: Are there new treatments being developed for Cushing’s Syndrome? Yes, there is ongoing research into new treatments for Cushing’s Syndrome. New medications that inhibit cortisol synthesis are in development and may be more effective with fewer side effects than older medications. New targeted therapies for ACTH-secreting pituitary adenomas are being studied. Gene therapy approaches to treat adenomas are being researched. Improved understanding of the genetic mutations causing Cushing’s Disease is leading to development of targeted therapies. Radiotherapy techniques are being improved for better outcomes. Clinical trials of new medications and approaches continue. As new treatments are developed, outcomes for people with Cushing’s Syndrome will continue to improve.
References and Further Reading
For more information about Cushing’s Syndrome and Cushing’s Disease, you can visit several trusted and authoritative sources that provide detailed information for patients and families. The World Health Organization at WHO.int provides comprehensive information about endocrine disorders including Cushing’s Syndrome and Cushing’s Disease. The Pituitary Foundation at PituitaryFoundation.org offers excellent patient education, family resources, support communities, information about treatments and research, and updates about developments in Cushing’s Disease care. The Cushing’s Support and Research Foundation at CushingsFriendsOrg provides patient support, educational resources, and information about living with Cushing’s Syndrome. MedlinePlus, a service of the National Library of Medicine at MedlinePlus.gov, has detailed medical information about Cushing’s Syndrome written in language that patients and families can easily understand. The National Institutes of Health at NIH.gov provides scientific information about Cushing’s Syndrome and Cushing’s Disease research, ongoing clinical trials, and latest discoveries about cortisol regulation and treatment. The five main reference links are: 1) WHO.int – Endocrine Disorders, 2) Pituitary Foundation, 3) Cushing’s Support and Research Foundation, 4) MedlinePlus – Cushing’s Syndrome, and 5) National Institutes of Health.
Disclaimer
This article adapts publicly available information from WHO’s Cushing’s Syndrome and Cushing’s Disease and endocrine disorder information pages. This content is for informational and educational purposes only and does not constitute medical advice. ObserverVoice.com is a news and information platform — not a healthcare provider. If you or someone you know has been diagnosed with Cushing’s Syndrome or Cushing’s Disease or shows signs of these conditions including progressive central obesity with fat redistribution, purple stretch marks, easy bruising, muscle weakness, high blood pressure, diabetes, mood changes, or other symptoms, please consult immediately with qualified healthcare professionals, endocrinologists, and pituitary specialists for proper diagnostic evaluation with twenty-four-hour urine cortisol, late-night salivary cortisol, dexamethasone suppression testing, and appropriate imaging and treatment planning. For more information, visit WHO.int and ObserverVoice.com.
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