UVA Today reached out to Dr. Mary Lee Vance, an endocrinologist at UVA Health and professor of medicine, to find out more about the condition and its effects on the body.

Q: What is Cushing syndrome?

A. Cushing syndrome is the production of too much cortisol. The diagnosis is based on clinical finds in blood, salivary and urine tests. The most common cause is iatrogenic, meaning it’s a consequence of treatment with steroids for other diseases, such as severe asthma or rheumatoid arthritis. It’s not one pill or injection that causes Cushing. It’s a consequence of prolonged and usually higher than normal doses of a steroid that we would use to replace cortisol.

The other causes of Cushing syndrome are pituitary and adrenal. The pituitary makes the hormone ACTH, which circulates through our body, and it tells adrenal glands to make cortisol.

Amy Schumer has iatrogenic Cushing, not a pituitary or adrenal gland tumor.

Q: What are the most common symptoms?

A: The consequences are usually weight gain, changes in body features, like rounded face, facial plethora, meaning it looks like they have too much blush on, fat above the collar bone and at the base of the neck, called “fat pads,” and loss of muscle mass and more fat in the abdomen.

Dr. Mary Lee Vance, professor of medicine at the University of Virginia School of Medicine and Endocrinologist at UVA Health, specializes in pituitary disorders. (Contributed photo)

High blood sugar or diabetes occur in about 50% of patients. [Other symptoms include] loss of bone, high blood pressure, thinning and loss of the front part of hair for women, thinning of the skin, which can get like tissue paper, lots of bruising, and red stretch marks over the abdomen and hips.

And then you can get psychological problems. Some [people are] depressed, they become short-tempered and irritable, and I always tell them, “That’s not your fault. That’s the Cushing’s.” There are degrees of how serious it is and how long they’ve had it, and not everyone gets all of these consequences.

Q: How is it treated?

A: For iatrogenic Cushing, if you are getting shots or pills from steroids, either reduce the [dose] or stop it, if possible. There are other drugs for illnesses that are treated with steroids. If it’s a pituitary source, you must have a dedicated, experienced pituitary neurosurgeon to go through the nose to the pituitary gland. One of the reasons I say “experienced” is because, for many of these people, the tumors are very tiny and may not even be seen on an MRI scan. If the tumor is in the adrenal gland, they need an adrenal gland surgeon to remove the tumor.

Q: How is Cushing syndrome distinct from Cushing disease?

A: The syndrome just means too much of a steroid. The disease refers specifically to the pituitary tumor.

Q: Why does Cushing syndrome affect women more often than men?

A: Now, that is a major question. No one knows. In children, it’s 50% boys and 50% girls. But in late adolescence, after puberty and into adulthood, it’s 80% women and 20% men. The theory that’s never been proven, but it makes sense, is that it may have something to do with the female hormone, estrogen.

Q: Is it curable?

A: Yes. If you can get the whole tumor out, they’re cured. If the Cushing is iatrogenic and a person has stopped the medicine/steroids, it will gradually improve, but it depends on how long the body has been exposed to high levels of steroids and how severe the dosage is.

If Cushing is untreated, a person has a three times higher mortality risk than someone else their age who doesn’t have Cushing.