Hirsutism and Cushing’s Syndrome

hirsutism cortisol

The human body secretes over fifty different hormones. Each plays its own unique role in keeping the body healthy and alive. One of the most important amongst them is the hormone known as cortisol.

Cortisol helps to regulate our blood pressure and our sleep-wake cycle, and manages our metabolism by controlling how the body uses carbohydrates, fats, and proteins. Because of its importance, cortisol levels are tightly regulated. Too much or too little creates a hormonal imbalance that can have large effects on the body, and can be noticed.

Cushing’s Syndrome is a medical condition caused by a high cortisol level. And hirsutism can be one of the key symptoms of its occurrence.

Hirsutism and Cushing’s syndrome

Hirsutism is one the most visible symptoms of Cushing’s Syndrome. However, before the link between hirsutism (excess hair growth) and Cushing’s Syndrome can be made, the underlying cause of the excess hair growth must first be identified. Other medical conditions such as polycystic ovary syndrome (PCOS), some medications or benign tumors are other possible causes of hirsutism. Depending on the cause of excess hair growth, different treatment options will be pursued. Therefore it is important for the doctor to find the true underlying cause behind the hirsutism. 

What is Cushing’s Syndrome?

Cushing’s Syndrome describes a rise in cortisol levels. It highlights a problem with cortisol production. Too much cortisol is either being secreted by the adrenal glands, or cortisol is being produced (inappropriately) by another part of the body.

There are many causes of Cushing’s syndrome, some of them are:

  • Corticosteroid medications 

Corticosteroids like Prednisolone are used to treat medical conditions such as  allergies, asthma or autoimmune conditions T aking corticosteroids for an extended period of time can lead to Cushing’s Syndrome.

  • Pituitary gland tumor

A noncancerous (benign) tumor of the pituitary gland can result in Cushing’s disease. The pituitary gland is located at the base of the brain. If it secretes an excess amount of ACTH (a hormone), this prompts the adrenal glands to make more cortisol. And this is known as Cushing’s disease. Hirsutism is a common symptom of this disorder along with weight gain, high blood pressure, rounding of the face, abdominal markings, and irregular menstruation.

Cushing’s disease should not be confused with Cushing’s syndrome. Cushing’s syndrome refers to excess cortisol in the body, regardless of the cause. When Cushing’s syndrome is caused by a pituitary tumor, it is called Cushing’s disease.

  • Tumors elsewhere in the body that produce a hormone called ACTH

Tumors elsewhere in the body that produce a hormone known as ACTH can cause Cushing’s syndrome. Rarely a tumor may develop in an organ that does not normally produce ACTH. The tumor will begin to secrete this hormone in excess, resulting in high cortisol levels.

Other sites (apart from the adrenal glands) that inappropriately rise cortisol levels are known as ectopic Cushing syndrome.

  • Tumors elsewhere in the body that produce a hormone called corticotropin-releasing hormone

A tumor elsewhere in the body that produces a hormone known as corticotropin-releasing hormone (CRH) may cause Cushing’s syndrome.

Symptoms of Cushing’s Syndrome

A good indication that hirsutism is the result of Cushing’s syndrome is the presence of other signs of a high cortisol. If the cause of hirsutism is due to a high cortisol level, these symptoms may also be present:

  • Weight gain
  • A fatty hump between your shoulders
  • A rounded face (known as moonface)
  • Pink or purple stretch marks on your skin of the abdomen, thighs, breasts and arms
  • Thinning, fragile skin that bruises easily
  • An increased number of infections
  • High blood pressure

In addition to the above, women and men may experience slightly different gender-specific symptoms. Women may notice an irregular period or no menstrual at all while men may suffer from a decreased libido or erectile dysfunction.

Complications of excess cortisol 

Cushing’s syndrome and the production of excess cortisol is a serious condition that can have far-reaching consequences. Without treatment, high levels of cortisol can lead to bone fractures, osteoporosis, type 2 diabetes or loss of muscle mass.

Diagnosis and Treatment of Cushing’s Syndrome and Hirsutism

The diagnosis of Cushing’s syndrome is made by a doctor after obtaining a medical history and conducting a physical exam. Due to the nature and seriousness of Cushing’s syndrome, extra attention will be paid to the diagnostic imaging tests. For example, an MRI or CT scan may be used to image the adrenal glands or other organs to see if they are the source of the cortisol production. 

If medical tests point to a diagnosis of Cushing’s syndrome, then further testing will try to pinpoint the exact cause. If the diagnosis is confirmed, your doctor will discuss the treatment options with you.

Meanwhile, it is possible to treat excess hair growth with traditional treatment options such as waxing, electrolysis or creams. The treatment options for hirsutism include methods such as:

Physical treatments – such as shaving, waxing or plucking. These are relatively cheap options that offer immediate results. But hair regrows within a short period of time. Side effects include irritation of the skin, folliculitis and redness.

Face creams- like Vaniqa are applied directly to the face. Results are usually seen after a few weeks of routine treatment. Once Vaniqa is stopped, hair growth will return.

Electrolysis –this is considered the only permanent way to remove hair. Due to its dependence on the skill of the electrologist, results may vary. A fine needle is inserted near the base of the hair shaft where heat or an electrical current is applied. This allows the hair to be removed. The technique is repeated over the course of a few sessions before permanent hair removal will be seen.

Laser treatments/IPL – are popular hair removal techniques. Lasers are used to destroy the hair follicle at the source. Their ease of use, long term results and good side effect profile have given these techniques widespread acceptance.

However, they should not be started until a detailed discussion with a doctor has first taken place. As some of these medications act on different hormones they may not be appropriate for everyone. Additionally, until a firm diagnosis has been given, they may not be safe to use. 


Cushing’s syndrome describes the presence of too high levels of Cortisol in the blood. This can have a variety of reasons, such as tumors or medications. If you are experiencing the symptoms of Cushing’s syndrome, make sure to discuss them with you doctor, as they can make a diagnosis and discuss your treatment options with you.

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