What is Cushing’s Syndrome?


Cushing’s syndrome, also known as hypercortisolism, is a medical condition characterized by a chronic excess of cortisol in the body. Cortisol is a hormone produced by the adrenal glands, which are located on top of the kidneys. It plays a crucial role in regulating various functions in the body, including metabolism, immune response, and stress response.

Important Symptoms of Cushing’s Syndrome

  • Wired at night
  • Trouble sleeping-trouble falling asleep or frequent awakenings
  • Severe fatigue-new onset
  • Abrupt weight gain without other cause such as decreased activity or depression
  • Decreased ability to exercise
  • Menstrual abnormalities
  • Cognitive changes- “brain fog”
  • Decreased libido-low interest in sex
  • Symptoms of adrenal insufficiency-joint pains, can’t get out of bed, nausea and vomiting
  • Depression, anxiety, mood-swings
  • Muscle atrophy
  • Central obesity
  • Thin skin
  • Buffalo hump
  • Round, red face
  • Bruising
  • Extra hair growth
  • Acne
  • Loss of hair on head
  • Stretch marks

How Is Cushing’s Diagnosed?

  1. Careful history and physical
  2. Change in weight and body habitus
  3. Look at old pictures
  4. Not all patients have all signs and symptoms, especially “early” and “episodic” patients.
  5. Important to diagnose early before devastating sequelae develop.
  6. Initial diagnosis most difficult aspect of Cushing’s syndrome.
  7. “Gestalt” with as much information as possible
  8. Episodic Cushing’s common, so one positive test may be worth more than 10 negative tests
  9. Best tests are 24 hour urines for urinary free cortisols (UFC) and 17-hydroxysteroids (17-OHS, only done at Labcorp and 11 PM-12 midnight salivary cortisols are the best tests and multiple tests should be done to catch “highs”
  10. Midnight serum cortisols are also good and can be done in a medical center, hospitals or emergency rooms.
  11. Dr. Friedman does not recommend the dexamethasone suppression test or the DDAVP stimulation test. Too many patients who end up having Cushing’s disease suppress to dexamethasone and have a normal response to DDAVP.

Health Medications to Treat Cushing’s

Endocrinologist, Dr. Friedman, often uses medications to treat Cushing’s syndrome. Unlikely other doctors that may take a long time to diagnose a patient with Cushing’s and then send the patient directly to surgery, Dr. Friedman puts all patients that he has diagnosed with Cushing’s syndrome on cortisol-lowering medications prior to pituitary surgery.

Cortisol-Lowering Health Medications Are Used for 4 Reasons:

  1. Medications that lower cortisol can get the patient feeling better right away
  2. The medications can determine if the patients’ symptoms are due to high cortisol. If the Cushing’s symptoms resolve with medications, they will likely resolve with pituitary surgery. If they do not resolve, the patient is unlikely to improve with surgery and the diagnosis of Cushing’s may need to be re-assessed.
  3. Lowering cortisol before surgery decreases the risks of surgery, which includes blood clots and infections.
  4. Lowering cortisol before surgery decreases the drop in cortisol after successful surgery, so cortisol withdrawal symptoms are less.

Dr. Friedman especially recommends ketoconazole; an in-depth article on ketoconazole can be found on He also uses Isturisa (osilodrostat), often in combination with ketoconazole. Many patients feel so well on the medications, they don’t want surgery. Dr. Friedman has patients that have done well on ketoconazole for over 10 years.

Read more on Medications to treat Cushings here.

Dr. Friedman has the most experience of using medications to treat Cushing’s disease of any Endocrinologist in the country.

For more personalized information, please click below to make an appointment.

Cushing’s syndrome is a rare disorder which can severely affect the patient. Symptoms of patients with Cushing’s syndrome include weight gain, easy bruising, menstrual irregularities,increased appetite, trouble sleeping, depression or mood swings, anxiety, fatigue and altered mentation(trouble concentrating or decreased memory) (1-3). Read More…

Patients with Cushing disease are thought to have progressive and unremitting symptoms if left untreated. We report a patient with documented Cushing disease that was untreated for 26 years. Read more….

During a diagnostic work up for Cushing’s Disease, I was challenged, as are many others, in determining when to test for elevated cortisol levels. I used a spreadsheet to capture a variety of symptoms on a daily basis and to help identify patterns that represented a “high”. Read more….

What are the signs of being cured from Cushing’s vs the signs of returning symptoms?

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Why did I get Cushing’s?

Is it my genes (DNA)?

Can it be passed on to my children?

Should I be tested for genetic changes?

Throughout this presentation we cover all these health care topics and more.

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Dr. Friedman was a guest on the Cushing’s Help BlogTalkRadio show on January 29, 2009 at 5:30 PST(8:30 EST), hosted by Mary O’Conner and Robin Smith. To listen to the show, go to BlogTalkRadio. Show number two can be heard here.

Dr. Friedman hosted a chat about Cushing’s disease on Feb.13 at 9:00pm eastern on

Magic Foundation’s Annual Convention


Dr Friedman’s MAGIC Foundation Presentations

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Dr. Friedman’s web site does not offer medical advice. These materials are offered for information purposes only. Do not act or rely upon information from without seeking professional medical advice. Additionally, the transmission of information from the web site, to you, is not intended to create nor does create a physician-patient relationship between you and Dr. Friedman.