What is the role of Cushing syndrome in the etiology of androgen excess?

Updated: Apr 07, 2020
  • Author: Mohamed Yahya Abdel-Rahman, MD, MSc; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Cushing syndrome is a rare but important cause of androgen excess, and hirsutism is present in approximately 81% of these patients. [58] Cushing syndrome (also called hypercorticism) is primarily the result of increasing levels of circulating cortisol or exogenous glucocorticoids. This syndrome can present insidiously with a spectrum of classic symptoms including rapid central weight gain (central obesity and “moon face”), abdominal striae, and signs of hyperandrogenemia including hirsutism, acne, and baldness.

Glucocorticoid therapy is currently the most common cause of Cushing syndrome but is unlikely to be associated with signs of increased androgens. In contrast, endogenous Cushing syndrome is often associated with hirsutism. Cushing syndrome can be secondary to an ACTH secreting pituitary tumor, which is called Cushing disease. Other cases of Cushing syndrome are related to autonomous cortisol secretion by the adrenal glands. [59] Adrenal tumors are associated with rapid onset of Cushing syndrome symptoms, often with hirsutism. [60] Rarely, Cushing syndrome is caused by ACTH secretion by other types of tumors such as small cell lung cancer.

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