Cushing's Disease vs. PCOS: What's the Difference?

Medically reviewed on December 10, 2023 by Jillian Foglesong Stabile, MD, FAAFP. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

• What Is Cushing’s Disease?
• What Is Polycystic Ovary Syndrome (PCOS)?
• Cushing’s Disease vs. PCOS: Similarities
• Differences Between PCOS And Cushing’s Disease
• Getting Diagnosed: How To Determine If You Have PCOS Or Cushing’s Disease
• Unlock Personalized Wellness Knowledge With Everlywell

Whether you’re researching hormonal imbalances or trying to find the root cause of recent symptoms, you might have heard of two conditions related to hormones: polycystic ovary syndrome (PCOS) and Cushing’s disease.

It’s critical to understand the differences between Cushing’s disease vs. PCOS, especially if you’re looking for relief from symptoms of hormonal imbalance—and this guide is here to help.

Below, we’ll break down Cushing’s disease and PCOS in-depth; we’ll cover symptoms, treatments, similarities, and differences. We’ll also provide tips you can use if you’re looking for answers about your symptoms.

What Is Cushing’s Disease?

Let’s start with an exploration of Cushing’s disease—a rare adrenal gland disorder related to adrenal function and cortisol production.[1]

Cushing’s Disease vs. Cushing’s Syndrome

While you might have heard the terms used interchangeably, “Cushing’s disease” and “Cushing’s syndrome” are different [1]:

• Cushing’s syndrome is a collection of symptoms that could occur when your adrenal glands produce too much cortisol—an important hormone that helps your body regulate stress, blood pressure, blood sugar, and more.
• Cushing’s disease is a specific type of Cushing’s syndrome. While many cases of Cushing’s syndrome are exogenous (i.e., they’re caused by prescription medications used to treat other conditions), Cushing’s disease is caused by tumors in the pituitary gland.

Tumors in the pituitary gland (located in the brain) produce excess amounts of adrenocorticotropic hormone (ACTH). ACTH signals the adrenal glands (two small glands located just above the kidneys) to produce cortisol—and as ACTH production increases, so does cortisol production.[1]

Symptoms of Cushing’s Disease

There are a few telltale physical symptoms of Cushing’s disease [1]:

• Thin arms and legs
• Excess fat at the base of the neck
• Fat around the edges of the face (sometimes called “moon face”)
• A fatty hump between the shoulder blades
• Easy bruising and dark stretch marks
• Unusual or unexpected weight gain

However, it’s important to remember that:

1. Some of these symptoms overlap with other conditions
2. Not all people living with Cushing’s disease experience all, some, or any of these symptoms

This can make Cushing’s disease particularly difficult to diagnose based on physical symptoms alone. So, to rule out other potential issues and learn more about your overall health, healthcare providers might employ one or more diagnostic tests:

• 24-hour urinary testing – This test involves collecting urine samples multiple times over a 24-hour period. These samples are then sent to a lab where technicians test the concentration of free cortisol in your urine.
• Late-night salivary test – Since cortisol levels typically drop after we fall asleep, healthcare experts can assess your cortisol levels at rest by collecting a saliva specimen later in the evening. A high cortisol level at night may suggest Cushing’s disease.
• Imaging – If your healthcare provider suspects that your test results could indicate Cushing’s disease, they may use advanced medical imaging (like CT scans or MRI) to look for potential tumors in your pituitary gland (or other locations throughout your body).

Treatments For Cushing’s Disease

There are currently two typical treatment options for people living with Cushing’s disease:

• Surgery – Healthcare providers often recommend surgically removing any pituitary tumors that are contributing to cortisol overproduction. And these procedures are effective—success rates are as high as 90%.[1]
• Radiation – If surgery on pituitary tumors isn’t possible, your provider may recommend a radiation therapy treatment. There are currently two radiation options: a six-week, low-dose treatment and a one-time, high-dose treatment.

Both of these treatment options will have an impact on your body’s ACTH and cortisol production. Sometimes, your healthcare professional may even recommend a specific Cushing syndrome diet. If your levels drop to below normal, your healthcare provider may prescribe hormone replacement drugs until your body adjusts.

What Is Polycystic Ovary Syndrome (PCOS)?

With a clear picture of Cushing’s disease, let’s transition to polycystic ovary syndrome (PCOS), a hormonal condition that has some symptom overlap with adrenal issues.

Causes Of PCOS

Healthcare experts still aren’t entirely sure what causes PCOS, but [2]:

• Genetics likely play a role – PCOS appears to run in families, so it could be caused by a specific gene mutation.
• Environmental factors haven’t been ruled out – One rodent study suggests that PCOS could be related to fetal development—exposures during pregnancy that could increase the likelihood of experiencing PCOS symptoms.[3]

However, scientists do know what probably causes most of the symptoms of polycystic ovarian syndrome: androgen levels.[2]

The ovaries produce both estrogen and androgens. While people with ovaries typically produce more estrogen than androgens, they need both to maintain normal reproductive functions.

However, for people living with PCOS, the ratio of estrogen to androgen production isn’t balanced: androgen levels are typically higher, and estrogen levels are usually lower.

This hormonal imbalance plays a key role in some of the major symptoms of PCOS, like:

• Irregular ovulation (or no ovulation at all)
• Enlargement of ovarian follicles (sacs where eggs grow and develop)
• Abnormal hair growth or acne

Symptoms Of PCOS

In addition to the three major symptoms above, people living with PCOS might also experience [4]:

• Irregular (or nonexistent) menstrual cycles
• Infertility or difficulty conceiving (though many people with PCOS do conceive)
• Weight gain and difficulty losing weight
• Very oily skin
• Dark patches of skin (a condition called acanthosis nigricans)

While symptoms like irregular menstrual periods or difficulty conceiving might warrant a visit to your healthcare provider, many people with PCOS may not recognize symptoms like excess hair growth, oily skin, or acne as unusual. This is just one of the reasons why PCOS is typically underdiagnosed.[4]

Treatments For PCOS

While there’s no cure for PCOS, there are numerous treatments recommended by healthcare providers, including [5]:

• Oral contraceptives – Since many birth control pills include the hormones estrogen and progestin, they can support a healthy hormone balance and potentially restore normal menstrual cycles for people living with PCOS.
• Insulin-sensitizing medications – Medications like metformin can help the body respond to insulin normally. Since many people living with PCOS struggle with blood sugar and insulin resistance, some healthcare providers prescribe insulin-sensitizing medications off-label for treating the symptoms of PCOS.
• Anti-androgen medications – While anti-androgen medications aren’t the right choice for people with PCOS who are trying to conceive, they can help reduce androgen production for other PCOS patients.
• Lifestyle changes – Various lifestyle choices can help people living with PCOS achieve a higher quality of life: eating a nutritious diet, exercising, and using acne medications are just a few examples.

Cushing’s Disease vs. PCOS: Similarities

Cushing’s disease and PCOS certainly have a few similarities:

• They’re related to hormone production – While Cushing’s disease is related to adrenal cortisol production and PCOS is mostly related to ovarian reproductive hormones, the conditions can both cause an abnormal hormone imbalance.
• They’re difficult to diagnose – Both Cushing’s disease and PCOS typically feature symptoms that overlap with other conditions or simply don’t raise alarm bells (like weight gain or oily skin). This can make them difficult to spot and diagnose.
• There are treatment options available – While healthcare experts still don’t understand as much about PCOS, there are treatment options currently available for both conditions.
• They can make a long-term health impact – Left untreated, both Cushing’s disease and PCOS could significantly impact your long-term health and wellness.

Differences Between PCOS And Cushing’s Disease

With the above similarities in mind, there are some crucial differences between Cushing’s disease vs. PCOS to understand:

• PCOS only affects people with ovaries – While Cushing’s disease can impact either biological sex, only people who were born with ovaries are at risk for PCOS.
• Hormonal imbalances have distinct origins – Cushing’s disease primarily concerns adrenal gland hormones, while PCOS is largely impacted by ovarian hormone production.
• Treatment availability – While there are some methods people living with PCOS can use to improve their quality of life, none of the treatments listed above are FDA-approved to treat PCOS—oral contraceptives, insulin-sensitizing medications, and anti-androgen drugs are all only prescribed off-label. Cushing’s disease, on the other hand, has two clinically tested and effective treatments.

Getting Diagnosed: How To Determine If You Have PCOS Or Cushing’s Disease

If you’re experiencing any of the symptoms listed throughout this article and you suspect that you might have PCOS or Cushing’s disease, getting in touch with a healthcare provider can help you discover the relief you deserve.

Here are some tips to keep in mind as you navigate the diagnostic process:

• Find a compassionate, experienced provider – Finding a provider well-versed in hormonal conditions is critical for people living with PCOS or Cushing’s disease. Since these conditions aren’t well understood yet, partnering with a specialist could help patients reach their goals.
• Pack your patience – Both PCOS and Cushing’s disease are diagnoses of exclusion—so, your provider will want to make sure you don’t have another condition before diagnosing you with either of these. Be patient as your provider investigates your health history; time spent learning about your body will help you on your treatment journey.
• Track your symptoms – Keeping track of your symptoms in a journal or on your smartphone can help you communicate thoroughly with your provider and monitor your progress once you start a treatment plan.

Unlock Personalized Wellness Knowledge With Everlywell

If you’re experiencing symptoms of a hormonal imbalance, understanding the differences between Cushing’s disease vs. PCOS can be a key piece of your wellness puzzle. As you explore your health, staying informed about any conditions you have will only further support your journey.

When you’re looking for convenient, accessible support for your wellness goals, turn to Everlywell. Our at-home test kits make testing for hormonal abnormalities discreet and easy, and our licensed telehealth providers can offer exceptional care for women’s health online and individualized treatment plans from the comfort of your own home.

Get started with a telehealth provider today to start your journey toward better health.

Related Content

Addison’s Disease vs. Cushing’s Syndrome: What's the Difference?

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Cushing Syndrome Diet: What to Know

References

1. Cushing’s syndrome. National Institute of Diabetes and Digestive and Kidney Diseases. May 2018. URL. Accessed November 12, 2023.
2. Polycystic ovary syndrome (PCOS). Eunice Kennedy Shriver National Institute of Child Health and Human Development. September 29, 2022. URL. Accessed November 13, 2023.
3. Goodarzi MO, Dumesic DA, Chazenbalk G, Azziz R. Polycystic ovary syndrome: Etiology, pathogenesis and diagnosis. Nature Reviews Endocrinology. 2011;7(4):219-231. doi:10.1038/nrendo.2010.217 URL. Accessed November 12, 2023.
4. What are the symptoms of PCOS? Eunice Kennedy Shriver National Institute of Child Health and Human Development. September 29, 2022. URL. Accessed November 13, 2023.
5. Treatments to relieve symptoms of PCOS. Eunice Kennedy Shriver National Institute of Child Health and Human Development. January 31, 2017. URL. Accessed November 13, 2023.

Jillian Foglesong Stabile, MD, FAAFP is a board-certified Family Physician. Since completing her residency training in 2010, she’s been practicing full-scope family medicine in a rural setting. Dr. Foglesong Stabile’s practice includes caring for patients of all ages for preventative care as well as chronic disease management. She also provides prenatal care and delivers babies. Dr. Foglesong Stabile completed a teaching fellowship in 2020 and teaches the family medicine clerkship for one of her local medical schools. Dr. Foglesong Stabile’s favorite thing about family medicine is the variety of patients she sees in her clinical practice.