Cushing vs PCOS: Spotting the Differences

Maanvi Kashyap
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Dr. Kaushal

Review medical content on WOW Rx Pharmacy, so that accurate drug use information is easily accessible to everybody.
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cushing vs pcos

Cushing’s syndrome (CS) and Polycystic Ovary Syndrome (PCOS) are endocrine disorders that predominantly affect women. 

Cushing’s syndrome is characterized by excessive cortisol production, leading to weight gain, central obesity, and muscle weakness. 

On the other hand, PCOS involves hormonal imbalances, ovarian dysfunction, and insulin resistance. 

Understanding the key differences between these disorders is vital for accurate diagnosis and appropriate management.

To know more about Cushing syndrome vs PCOS, read on.

Overview of Cushing Syndrome vs. PCOS

The Overview of Cushing vs PCOS includes:

CauseOverproduction of cortisol due to adrenal or pituitary issuesHormonal imbalances, primarily excess androgens
SymptomMoon face, buffalo hump, weight gain, skin changes, HirsutismMenstrual irregularities, Hirsutism, weight gain
DiagnosisPhysical exam, cortisol level tests, imaging (X-ray, MRI), Determining the source of excess cortisolMedical history, physical exam, hormone and blood tests, ultrasound, criteria assessment to rule out other conditions
TreatmentReduce steroid use, surgery or radiation for tumors, medications to inhibit cortisol, lifestyle changesLifestyle changes, medication, fertility treatments

Understanding Cushing’s Syndrome and PCOS

Cushing’s syndrome is a hormonal disorder caused by exposure to high cortisol levels, a stress hormone. 

It can result from the overproduction of Cortisol by the Adrenal glands or corticosteroid medications.

PCOS is a hormonal disorder characterized by imbalances in reproductive hormones, primarily affecting women of reproductive age. 

It involves the formation of tiny cysts on the ovaries, disrupted ovulation, and elevated Androgen (male hormone) levels.

Symptoms of Cushing vs PCOS

FatigueSource: marchenko_family

Cushing’s syndrome symptoms develop gradually and vary from person to person. 

Some individuals may experience only a few signs, while others may have more noticeable changes. 

Here are some common symptoms of CS:

  • Round and full face (moon face)
  • Fat accumulation between the shoulders (buffalo hump)
  • Weight gain, specifically in the abdominal area
  • Thinning of the skin, which may lead to easy bruising and the appearance of pink or purple stretch marks on the abdomen
  • Excessive body hair growth 
  • High blood pressure
  • Elevated blood sugar levels
  • Fatigue and difficulty sleeping due to disruptions in normal sleep patterns influenced by cortisol release
  • Mood swings and feelings of sadness.
  • Weakness in muscles, making it challenging to stand up from a seated position
  • Loss of bone density 
  • Sexual abnormalities 
  • Irregular menstrual periods and potential development of more masculine features (virilization)

PCOS can lead to various symptoms, which too can vary individually.

These symptoms include:

  • Menstrual irregularities
  • Irregular ovulation or no ovulation
  • Excess body hair growth, having on the face, chest, back, or buttocks (Hirsutism)
  • Weight gain, especially around the belly
  • Thinning hair and hair loss
  • Acne or oily skin
  • Darkening of the skin (Acanthosis Nigricans) 
  • Enlarged ovaries with many small cysts
  • High levels of male sex hormones (Androgens)
  • Insulin resistance

Cushing’s syndrome and PCOS share several common symptoms. 

These include gaining weight, excessive hair growth (Hirsutism), irregular menstrual periods, hair thinning, and acne. 

Cushing’s syndrome and polycystic ovary syndrome (PCOS) are associated with obesity, high blood pressure, and difficulty regulating blood sugar levels. 

If you notice any of the above mentioned symptoms, consult a doctor immediately.

Causes of PCOS vs Cushing syndrome

The causes of PCOS and Cushing syndrome are different. 

The exact cause of PCOS is not fully understood, but it involves hormonal imbalances, precisely an excess of male hormones (Androgens). 

Cushing’s syndrome is caused by too much Cortisol often due to Pituitary adenoma, a hormone produced by the Adrenal glands or Ectopic tumor or excessive use of steroids.

Cushing disease is one most common type of Cushing’s syndrome, making upto 70% of all cases.

These conditions stem from distinct hormonal issues, leading to their specific symptoms and effects on the body.

Diagnosis of PCOS vs Cushing

Diagnosing Cushing’s syndrome and PCOS can be challenging because they have overlapping symptoms and laboratory findings.


Ultrasound checkup for regular monitoringSource: undefined_undefined_from_Getty_Images
Ultrasound checkup

Diagnosis of PCOS includes:

  • Medical history and physical examination: A doctor considers the medical history and symptoms and performs a physical exam
  • Criteria assessment: PCOS is diagnosed when at least two of the three Rotterdam criteria are met, and other conditions similar to PCOS are ruled out
  • Hormone and blood tests: Blood tests measure hormone levels, including testosterone and other reproductive hormones like estrogen and follicle-stimulating hormone (FSH)
  • Ultrasound: An ultrasound exam checks the ovaries appearance and measures the uterine lining’s thickness
  • Pelvic exam: A pelvic exam examines the reproductive organs for any abnormalities or changes
  • Glucose tolerance test: Sometimes, a glucose tolerance test may be recommended to assess how your body responds to sugar
The Rotterdam criteria for PCOS include:

  • Oligo- or anovulation
  • Hyperandrogenism (excess Androgen)
  • Polycystic ovaries on ultrasound (≥ 12 follicles measuring 2-9 mm in diameter and an ovarian volume > 10 mL in at least one ovary)
  • Cushing’s Syndrome

    Diagnosis of Cushing syndrome includes:

    • Physical examination: Doctors look for specific signs of Cushing’s syndrome, such as a round face, a hump on the back of the neck, and thin, bruised skin with stretch marks
    • Laboratory tests: Laboratory tests are performed to measure cortisol levels in the body. This can be done through urine, saliva, or blood tests. More tests may be done to confirm the diagnosis and determine the underlying cause of excess cortisol production
    • Imaging tests: An X-ray of the adrenal or pituitary glands may be used to identify any tumors that could be causing the excess cortisol production
    • Determining the source of excess Cortisol: Once Cushing’s syndrome is diagnosed, further tests are conducted to identify the source of the excess Cortisol

    In addition to symptoms, medical history, physical examination, and tests distinguish the two conditions. 

    It’s important to consider other disorders like thyroid issues and congenital adrenal hyperplasia that can present similar symptoms. 

    Seeking medical expertise is crucial for an accurate diagnosis and appropriate treatment.

    Treatment of Cushing vs PCOS

    Meditation to manage stressSource: yuriyseleznev
    Meditation to manage stress

    Treatment approaches for Cushing’s syndrome and Polycystic Ovary Syndrome (PCOS) differ based on the specific condition.

    Cushing syndrome

    Treatment varies depending on the cause of excess cortisol production.

    • If it’s due to long-term steroid medication use, the dosage may be gradually reduced, or alternative medications may be prescribed
    • Surgical removal of tumors causing excess Cortisol may be necessary
    • Radiation therapy or medications that inhibit cortisol production may be used in certain cases
    • Lifestyle changes like weight loss, exercise, and stress reduction may help manage symptoms


    Treatment depends on individual symptoms and goals.

    • Lifestyle changes, including healthy eating, regular exercise, and weight management, can be beneficial
    • Medications like birth control pills, Anti-Androgens, or Metformin may be prescribed to regulate menstrual cycles, lower androgen levels, and improve insulin sensitivity
    • Fertility treatments like ovulation induction or in vitro fertilization (IVF) may be necessary for those having trouble getting pregnant
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    Cushing’s syndrome is a hormonal disorder caused by high cortisol levels, while PCOS is a hormonal disorder affecting women with imbalanced reproductive hormones and ovarian cysts. 

    Symptoms of Cushing’s include weight gain, a round face, and thin skin, while PCOS symptoms include irregular periods, excessive hair growth, and weight gain. 

    Diagnosis involves a medical history, physical exams, hormone tests, and ultrasounds for both conditions. 

    Treatment options differ depending on the condition and may involve lifestyle changes, medications, or surgery. 

    Seeking medical advice is essential for an accurate diagnosis and appropriate treatment.

    Frequently Asked Questions

    How to differentiate cushing and PCOS?

    Cushing’s syndrome and PCOS can have similar symptoms such as weight gain, Hirsutism, and menstrual irregularities. However, key differences include the source of hormonal imbalance (excess cortisol in Cushing’s vs. androgen imbalance in PCOS) and diagnostic criteria. Medical evaluation is essential for accurate differentiation.

    Can Cushing’s be mistaken for PCOS?

    Cushing’s syndrome can be mistaken for PCOS because they share similar symptoms, like weight gain and irregular periods. However, they have different causes and hormone imbalances, so it’s important for doctors to do specific tests to diagnose each condition correctly.

    What is commonly mistaken for PCOS?

    Endometriosis, Hypothyroidism, Cushing, and adrenal hyperplasia are some conditions commonly mistaken for PCOS. These conditions share symptoms like irregular periods, hormonal imbalances, and fertility issues. It’s essential to consult with a healthcare professional to diagnose and differentiate between these conditions for appropriate treatment accurately.

    What hormone is highest in PCOS?

    In PCOS, the hormone Androgen is often higher than normal levels. Androgen is a male hormone that is also present in women, but excessive amounts can cause disruption in the balance of hormones in the body and contribute to the symptoms of PCOS.

    Is Cushing’s curable?

    Cushing’s syndrome can be treatable and managed, but it may not always be completely curable. The specific treatment approach depends on the underlying cause. Treatment aims to reduce cortisol levels, control symptoms, and address any associated conditions. Regular monitoring and medical management are typically necessary to maintain optimal health.

    Can Cushing’s cause ovarian cysts?

    Cushing’s syndrome can cause ovarian cysts in some cases, but they are not a defining feature of the condition. Ovarian cysts are found in almost half of the women with Cushing’s syndrome, but they can also occur in conditions like PCOS.

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