Cushing's syndrome is a serious
endocrine disease caused by chronic, autonomous, and excessive secretion of
cortisol. The syndrome is associated with increased mortality and impaired quality of life because of the occurrence of comorbidities. These clinical complications include
metabolic syndrome, consisting of systemic arterial
hypertension,
visceral obesity, impairment of
glucose metabolism, and dyslipidaemia; musculoskeletal disorders, such as
myopathy,
osteoporosis, and skeletal fractures; neuropsychiatric disorders, such as impairment of cognitive function, depression, or
mania; impairment of reproductive and sexual function; and dermatological manifestations, mainly represented by
acne,
hirsutism, and
alopecia.
Hypertension in patients with
Cushing's syndrome has a multifactorial pathogenesis and contributes to the increased risk for
myocardial infarction,
cardiac failure, or
stroke, which are the most common causes of death; risks of these outcomes are exacerbated by a prothrombotic
diathesis and hypokalaemia. Neuropsychiatric disorders can be responsible for suicide.
Immune disorders are common; immunosuppression during active disease causes susceptibility to
infections, possibly complicated by
sepsis, an important cause of death, whereas immune rebound after disease remission can exacerbate underlying
autoimmune diseases. Prompt treatment of
cortisol excess and specific treatments of comorbidities are crucial to prevent serious clinical complications and reduce the mortality associated with
Cushing's syndrome.