Cushing syndrome

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Teoría 
Diagnóstico 
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Última revisión: 14 Aug 2025

Última actualización: 10 Jun 2025

Cushing syndrome is the clinical manifestation of pathologic hypercortisolism from any cause.

Exogenous corticosteroid exposure is the most common cause of Cushing syndrome.

Cushing disease, which is hypercortisolism caused by an adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma, is the most common cause of endogenous Cushing syndrome, and is responsible for 70% to 80% of cases.

It may be difficult to distinguish patients with mild Cushing syndrome from those with the metabolic syndrome (central obesity with insulin resistance, and hypertension). Features more specific to Cushing syndrome include proximal muscle weakness, supraclavicular fat pads, facial plethora, violaceous striae, easy bruising, premature osteoporosis, and hypokalemia.

After excluding exogenous corticosteroid use, patients with suspected Cushing syndrome should be tested for hypercortisolism with one of three high-sensitivity tests (late-night salivary cortisol, 1 mg overnight low-dose dexamethasone suppression testing, or 24-hour urinary free cortisol).

At least one additional test should be performed to confirm hypercortisolism in patients with a positive initial screening test.

Once endogenous hypercortisolism is confirmed, plasma ACTH should be measured. If ACTH is suppressed, diagnostic testing should focus on the adrenal glands. If ACTH is not suppressed, pituitary or ectopic disease should be sought.

Surgical resection of the pituitary, adrenal, or neuroendocrine tumor that is causing hypercortisolism is the primary treatment of choice in the vast majority of patients with endogenous Cushing syndrome.

Definición

Cushing syndrome is the clinical manifestation of pathologic hypercortisolism from any cause. Patients often display weight gain with central obesity, facial rounding and plethora, proximal muscle weakness, and thinning of the skin. They also develop metabolic complications including diabetes mellitus, dyslipidemia, metabolic bone disease, and hypertension. The most common cause of Cushing syndrome is exogenous corticosteroid exposure. Endogenous causes are ACTH-secreting pituitary tumors (termed Cushing disease), ectopic ACTH-secreting tumors, and autonomous adrenal cortisol overproduction (ACTH-independent Cushing syndrome).[1][2]

Anamnesis y examen

Principales factores de diagnóstico

facial plethora
supraclavicular fullness
violaceous striae
absence of pregnancy
menstrual irregularities
absence of malnutrition
absence of alcoholism
absence of physiologic stress
linear growth deceleration in children

Todos los datos

Otros factores de diagnóstico

female sex
hypertension
glucose intolerance or diabetes mellitus
premature osteoporosis or unexplained fractures
weight gain and central obesity
acne
psychiatric symptoms
decreased libido
easy bruisability
weakness
facial rounding
dorsocervical fat pads
unexplained nephrolithiasis
venothrombolic event
hirsutism

Todos los datos

Factores de riesgo

exogenous corticosteroid use
pituitary adenoma
adrenal adenoma
adrenal carcinoma
neuroendocrine tumors
thoracic or bronchogenic carcinoma

Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

urine pregnancy test
serum glucose
late-night salivary cortisol
1 mg overnight dexamethasone suppression test
24-hour urinary free cortisol
48-hour 2 mg (low-dose) dexamethasone suppression test

Todos los datos

Tests to avoid

serum cortisol

Todos los datos

Pruebas diagnósticas que deben considerarse

morning plasma adrenocorticotropic hormone (ACTH)
plasma dehydroepiandrosterone sulfate (DHEAS) level
pituitary MRI
adrenal imaging
high-dose dexamethasone suppression test
inferior petrosal sinus sampling (IPSS)
CT of chest, abdomen, and pelvis
MRI chest
octreotide scanning
gallium-68 dotatate PET/CT

Todos los datos

Algoritmo de tratamiento

En curso

Cushing disease (adrenocorticotropic hormone [ACTH]-secreting pituitary tumor)

ectopic ACTH or corticotropin-releasing hormone (CRH) syndrome

ACTH-independent due to unilateral adrenal carcinoma or adenoma

ACTH-independent due to bilateral adrenal disease (hyperplasia or adenoma)

mild autonomous cortisol secretion (previously known as subclinical Cushing syndrome)

Colaboradores

Autores

Maria Fleseriu, MD, FACE

Professor of Medicine (Endocrinology) and Neurological Surgery

Director

Pituitary Center

Oregon Health & Science University

Portland

Divulgaciones

MF is on the Endocrine Society's Board of Directors. She holds a research grant to the university for clinical studies as principal investigator for Crinetics and Sparrow Pharmaceuticals, and is an occasional scientific consultant for Crinetics, Recordati, Sparrow Pharmaceuticals, and Xeris Pharmaceuticals. MF is an author of several references cited in this topic.

Agradecimientos

Dr Maria Fleseriu would like to gratefully acknowledge Dr Ty Carroll and Dr James Findling, contributors to a previous version of this topic.

Divulgaciones

TC is an author of a number of references cited in this topic. He is an investigator in clinical trials sponsored by Corcept. JF is an author of a number of references cited in this topic. He is a consultant for, and investigator in, clinical trials sponsored by Corcept and Novartis.

Revisores por pares

Paul M. Stewart, FRCP FMedSci

Professor of Medicine

Director of Research

College of Medical and Dental Sciences

University of Birmingham

Honorary Consultant Physician

Queen Elizabeth Hospital

Birmingham

Divulgaciones

PMS declares that he has no competing interests.

Antoine Tabarin, MD

Head

Department of Endocrinology

University Hospital of Bordeaux

Pessac

France

Divulgaciones

AT declares that he has no competing interests.

Liliana Contrersas, MD

Chief

Endocrine Research Department

Instituto de Investigaciones Médicas A. Lanari

University of Buenos Aires and IDIM-CONICET

Buenos Aires

Argentina

Divulgaciones

LC declares that she has no competing interests.

Philip R. Orlander, MD

Professor of Medicine

Director

Division of Endocrinology, Diabetes & Metabolism

University of Texas Medical School

Houston

Divulgaciones

PRO declares that he has no competing interests.

Mouhammed Amir Habra, MD, FACP, FACE

Assistant Professor

Department of Endocrine Neoplasia and Hormonal Disorders

Division of Internal Medicine

University of Texas MD Anderson Cancer Center

Houston

Divulgaciones

MAH declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

Fleseriu M, Auchus R, Bancos I, et al. Consensus on diagnosis and management of Cushing's disease: a guideline update. Lancet Diabetes Endocrinol. 2021 Dec;9(12):847-75.Texto completo Resumen

Nieman LK, Biller BM, Findling JW, et al. Treatment of Cushing’s syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015 Aug;100(8):2807-31.Texto completo Resumen

Feelders RA, Newell-Price J, Pivonello R, et al. Advances in the medical treatment of Cushing's syndrome. Lancet Diabetes Endocrinol. 2019 Apr;7(4):300-12. Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales
- Obesity
- Metabolic syndrome
- Primary aldosteronism
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Guías de práctica clínica
- NCCN clinical practice guidelines in oncology: neuroendocrine and adrenal tumors
- Clinical practice guideline on the management of adrenal incidentalomas
Más Guías de práctica clínica
Folletos para el paciente
Cushing syndrome caused by an internal problem
Cushing syndrome caused by medication
Más Folletos para el paciente
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Cushing syndrome

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

Otros factores de diagnóstico

Factores de riesgo

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

Tests to avoid

Pruebas diagnósticas que deben considerarse

Algoritmo de tratamiento

Cushing disease (adrenocorticotropic hormone [ACTH]-secreting pituitary tumor)

ectopic ACTH or corticotropin-releasing hormone (CRH) syndrome

ACTH-independent due to unilateral adrenal carcinoma or adenoma

ACTH-independent due to bilateral adrenal disease (hyperplasia or adenoma)

mild autonomous cortisol secretion (previously known as subclinical Cushing syndrome)

Colaboradores

Autores

Maria Fleseriu, MD, FACE

Divulgaciones

Agradecimientos

Divulgaciones

Revisores por pares

Paul M. Stewart, FRCP FMedSci

Divulgaciones

Antoine Tabarin, MD

Divulgaciones

Liliana Contrersas, MD

Divulgaciones

Philip R. Orlander, MD

Divulgaciones

Mouhammed Amir Habra, MD, FACP, FACE

Divulgaciones

Peer reviewer acknowledgements

Disclosures

Referencias

Artículos principales

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales

Guías de práctica clínica

Folletos para el paciente

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión para acceder a todo el BMJ Best Practice