syndrome is a condition?? Definition, etiology, Clinical and Manifestations of Cushing's Syndrome

Cushing's Syndrome

Definition of Cushing's Syndrome

Cushing's syndrome is a condition that results from the combined metabolic effects of persistently elevated blood levels of glucocorticoids. These high levels can occur spontaneously or because of the administration of pharmacological doses of glucocorticoid compounds. (Sylvia A. Price; Pathophysiology, p. 1088).

Cushing's syndrome is a clinical picture that arises due to a long-term increase in plasma glucocorticoids in pharmacological doses (iatrogenic). (Wiliam F. Gaming, Medical Physiology, page 364).

Cushing's syndrome is caused by excessive stress on adrenocortical steroids, especially cortisol (IDI). Edition III Volume I, p. 826).

Cushing's is the maintenance result of abnormally high blood cortisol levels due to hyperfunction of the adrenal cortex. (Children's Health, Issue 15, 1979).

Cushing's syndrome is a condition caused by the combined metabolic effects of persistently elevated levels of glucocorticoids in the blood (Pathophysiology, p. 1089).

The etiology of Cushing's syndrome

  1. Cushing's syndrome is caused by excessive secretion of cortisol or corticosterone, excess stimulation of ACTH results in hyperplasia of the renal anal cortex in the form of adenomas or carcinomas that are not ACTH dependent, which also causes Cushing's syndrome. Likewise, pituitary hyperactivity, or other tumors that secrete ACTH. Cushing's syndrome caused by a pituitary tumor is called Cushing's disease. (Surgery textbook, R. Syamsuhidayat, p. 945).
  2. Cushing's syndrome may result from long-term administration of pharmacological doses of glucocorticoids (iatrogenic) or by excessive cortisol secretion in disorders of the hypothalamic-pituitary-adrenal axis (spontaneous) in Cushing's syndrome. Spontaneously, adrenal cortex hyperfunction occurs as a result of overstimulation by ACTH or due to adrenal pathology resulting in abnormal cortisol production. (Sylvia A. Price; Pathophysiology, p. 1091)
  3. Elevated levels of ACTH (not always due to pituitary basophil cell adenoma).
  4. The high level of ATCH is due to the presence of tumors outside the pituitary, such as lung tumors, and pancreas that secrete "ACTH like substance".
  5. Adrenal neoplasms are adenomas and carcinomas.
  6. Iatrogenic is the long-term administration of glucocorticoids in pharmacological doses. Found in patients with rheumatoid arthritis, asthma, lymphoma, and generalized skin disorders receiving synthetic glucocorticoids as anti-inflammatory agents.

Clinical Manifestations of Cushing's Syndrome

If there is excessive production of adrenal cortex hormones then growth arrest, obesity, and musculoskeletal changes will occur along with glucose intolerance.

The classic features of Cushing's syndrome in adults are central obesity with a buffalo hump in the posterior neck and supraclavicular area, a large body, and relatively thin extremities. The skin becomes thin, fragile, and easily injured, ecchymosis (bruising) and will often occur. 

The patient complains of weakness and fatigue. Sleep disturbances often result from changes in the diurnal secretion of cortisol. Excessive catabolism will occur, causing muscle wasting and osteoporosis. Symptoms of kyphosis, back pain, and vertebral compression fractures may occur. Sodium and water retention result from increased mineralocorticoid activity, leading to hypertension and CHF.

Patients will show facial features such as the moon or moon face and the skin looks more oily and acne grows so that the susceptibility to infection increases. Significant hyperglycemia or diabetes may occur. Patients may also report weight gain, healing, minor injuries, slowing and symptoms of bruising.

In female patients of any age, virilization may occur as a result of excessive androgen production. Virilization is characterized by the emergence of

 masculine and diminishing traits. In this condition, there is excessive facial hair growth (hirsutism), breast atrophy, stopped menstruation, enlarged clitoris, and a deeper voice. Libido will disappear in male and female patients.

Changes occur in mental and emotional activity, sometimes psychosis is found. Usually, there is distress and depression that will increase along with the more severe the physical changes that accompany this syndrome. If this syndrome is the result of a visual disturbance of a pituitary tumor, it may result from compression of the optic chiasm by a growing tumor.


Smeltzer C. Suzanne, Brunner & Suddarth,   Buku Ajar Keperawatan Medikal Bedah, Jakarta, EGC ,2002.

Baradero  Mary,   Klien Gangguan Endokrin, jakarta, EGC, 2009.


Sylvia A. Price; Patofisiolgi Konsep klinis Proses-Proses Penyakit ; 1994 EGC; Jakarta

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