Non-modifiable Age : 20 50 years old Sex : Female (much more common in women)

Modifiable Chronic use of corticosteroid medication Pituitary micro adenoma Tumor in the adrenal Multiple endocrine neoplasia type I Ectopic ACTH secreting tumor Irregular sleep pattern Asthma Rheumatoid Arthritis Depression, alcoholism, & malnutrition

Growth of ACTH secreting tumor

Synthesis and increased secretion of ACTH

ACTH stimulate adrenal cortex to secrete cortisol Synthesis and secretion of cortisol

Increased cortisol

Suppression of cortisol and ACTH secretion

Decreased level of ACTH

Atrophy of remaining adrenal cortex

Alteration of remaining adrenal cortex

Alteration of cortisol secreting activity

Prolonged and excessive cortisol level

CUSHINGS SYNDROME