Television viewers led Amy Schumer to this diagnosis

After comedian Amy Schumer appeared on several talk shows promoting the second season of her television show, Life & Beth, viewers commented on social media that her face had gotten rounder. Instead of being insulted, Schumer expressed gratitude, because the comments led her to a diagnosis of Cushing’s syndrome.

Schumer reported that the condition was caused by previous steroid treatment for endometriosis.

“In Amy Schumer’s case, the reason why she has Cushing’s syndrome is because she has received too many steroid injections,” said endocrinologist Mary Crowell, MD, at the Endocrine Center of Cape Cod in Hyannis. “The vast majority of cases of Cushing’s syndrome are caused by taking too many exogenous steroids for too long. Exogenous means outside your body rather than endogenous.”

Cushing’s syndrome is caused when those exogenous steroids cause an elevation of the hormone cortisol. The symptoms include:

• A round moon-shaped face
• An apple-shaped body with very skinny legs
• Diabetes or elevated blood sugars
• High blood pressure
• Mood disorders, like anxiety and depression
• Osteoporosis
• Menstrual troubles
• Muscle weakness
• Bruising easily

Each of these symptoms has a logical explanation based on what cortisol does in the body, Dr. Crowell said. It tends to get a bad rap, but it is an essential hormone we need for stress management and regulation. It’s made by the adrenal glands, which sit on top of the kidneys. The adrenal glands also make adrenaline, also known as epinephrine.

Adrenaline and cortisol are kind of like the one-two responses to stress. When a stressful event happens, the adrenaline kicks in first, which makes your heart rate go up and gives you energy to respond.

“But then the next thing that happens is your adrenals make cortisol,” Dr. Crowell said. “Cortisol is kind of your middle or longer-term way to manage stress. One of the primary things cortisol does is provide your body and your brain with more energy to get out of that stressful situation.”

It does so by converting muscle and fat into sugar to raise the blood sugars to give you energy. But at the same time, it puts the brakes on all non-essential body functions. So, it puts a brake on inflammation on your immune system. It also puts a break on growth, bone formation and your reproductive system. 

“All of these things are very adaptive and important stress responses,” Dr. Crowell said. “The problem is, when it is too much for too long, and that’s when Cushing’s syndrome comes into play.”

Different Facets

“Cushing’s syndrome is a collection of symptoms and physical findings that are often seen together to suggest elevated cortisol levels,” she said. “But the causes of Cushing’s syndrome can be multiple things. Doctors think about Cushing’s syndrome based on whether the excess cortisol production is dependent or independent of ACTH.”

ACTH or adrenocorticotropic hormone is the message the pituitary gland sends to the adrenals to make cortisol. Normally this is a well-regulated system in which the pituitary measures cortisol levels in your blood and uses input from the body to manage stressors. It then produces ACTH in response.

Sometimes, however, a pituitary tumor can make too much ACTH. That forces the adrenals to make too much cortisol. This is called ACTH-dependent Cushing’s syndrome. Very rarely, some lung cancers can make ACTH as well, Dr. Crowell said.

“ACTH-independent Cushing’s syndrome happens when excess cortisol is not being produced through the action of ACTH in the pituitary,” she explained, “This can happen when there is an adrenal tumor secreting excess cortisol directly, or if patients are taking too much steroid, as in Amy Schumer’s case.”

Then there is pseudo-Cushing’s.

“We called it physiological hypercortisolism because there’s nothing wrong with your brain,” Dr. Crowell said. “There’s nothing wrong with your adrenals. They are doing what they’re supposed to do but, unfortunately, you’re starting to see some of the damage of long-term elevated cortisol.”

Pseudo-Cushing’s can be seen in people who are experiencing depression. Other causes include physical stress, being an elite athlete, poorly controlled diabetes and people with alcohol use disorder.

“The difference is that pseudo-Cushing’s physiological hypercortisolism is a normal adrenal system response,” Dr. Crowell said. “Your body is just telling those adrenals to make that cortisol, whereas with Cushing’s syndrome, there is a problem. Either you are getting too much steroids because you are taking prednisone or there is a tumor somewhere that is causing that cortisol. The challenge in endocrinology is telling the difference.”

Those with pseudo-Cushing’s don’t have all the same symptoms that are consistent with Cushing’s syndrome, but the chronic stress it causes can raise blood pressure and cardiovascular risk. It also can lead to mood issues. The way to manage high cortisol levels is to manage the chronic stress, because your body is just doing what it is designed to do when dealing with stress.

Lowering Stress

Dr. Crowell recommends the following ways to reduce stress and lower cortisol:

• Therapy
• Meditation
• Exercise
• Get the proper amount of sleep
• Spend time with friends
• Get involved with community organizations

“Fortunately, in Amy Schumer’s case, the cause was exogenous steroids, so stopping the steroids will remove the excess cortisol and her symptoms should go away,” Dr. Crowell said.