Cushing Syndrome/Disease is a medical condition occasionally associated with infertility. The main condition is caused by too much production of the cortisol hormone. It is observed in about 1-2 per 100,000 people each year and more likely in women than in men. 

Cushing syndrome or Cushing's disease is the result of chronic exposure to high concentrations of cortisol (a glucocorticosteroid produced in the adrenal gland), either:

  • Adrenal tumors: benign or malignat tumors outside the pituitary secreting large amounts of ACTH hormone causing excessive cortisol hormone production
  • Pituitary adenoma's - Cushing's disease: Benign tumoprs of the pituitary gland secreting excessive cortisol production.
  • Administration of ACTH 
  • Administration of glucocorticoids  
  • Increased secretion of ACTH or cortisol.

Cushing syndrome is a result of the increased circulating levels of the steroid hormone cortisol. Symptoms include:

  • weight gain in the face, rounded face (moon facies), truncal obesity (fat especially around the waist), "buffalo hump" (increased fatty tissue in the supraclavicular region)
  • excessive hair growth
  • blurry vision
  • poor wound healing
  • high blood pressure
  • diabetes
  • depression and/or mood swings
  • fatigue (tiredness)
  • purple striae (linear streaks) on the skin
  • muscle weakness
  • easy bruisability and low fracture threshold for the ribs and vertebrae
  • carbohydrate intolerance or frank diabetes mellitus
  • hypertension
  • amenorrhea

The diagnosis is made with several tests:

  • 24-hour urine test to measure the urine amount and that tests cortisol levels. levels higher than 50-100 microgram a day suggest Cushing syndrome.
  • Low dose dexamethasone suppression test taking a small amount of dexamethasone at 11 PM then having blood drawn the following morning. In patient's with Cushing syndrome cortisol may be increased while in normal patients it's decreased (under 1.8 mg/dl).
  • Late-night salivary cortisol checks for elevated cortisol levels at night between 11 PM and 1 AM. Increased levels at that time suggest Cushing syndrome