Definition and Overview

The adrenal glands, which are located on top of the kidneys, produce a variety of hormones, including cortisol. Cortisol is an essential hormone that regulates metabolism and other important bodily functions.

Too much or low amounts of cortisol can cause health problems. Excessive amounts of cortisol is referred to as hypercortisolism. It is also known as Cushing’s syndrome. It was first reported by a neurosurgeon named Harvey Cushing in 1912.

The condition can be cured if caught and treated early. If left untreated, it can be a potentially deadly disease. But it is very rare. According to statistics, only about two to three people per million have it. Up to 70% of cases involve patients aged between 20 and 50.

It is important to note though that there is a good possibility that the actual number of cases is much higher. This is because many cases are misdiagnosed as either type 2 diabetes or osteoporosis. This happens because the conditions share similar symptoms. Moreover, some cases are left undiagnosed.

Causes of Condition

The main causes of too much cortisol are:

  • Abnormal growths - These refer to both benign and malignant tumours. Examples of benign tumours are adrenal and pituitary adenomas. Cancerous tumours, on the other hand, include adrenal cancer and cancers that affect the lungs and thyroid.

  • Drugs containing glucocorticoid - Steroid drugs are prescribed for the treatment of a number of conditions. These include allergies and asthma. They are also used to prevent the body from rejecting transplanted tissues. In addition, they are used for the treatment of autoimmune disorders.

  • Emotional stress - In addition to drugs and tumours, the body may also produce excessive amounts of cortisol due to emotional stress. Patients with a highly active lifestyle or drink alcohol regularly are also at risk of the condition.

  • Other possible causes - This condition may also be inherited. It can also be caused by surgery, injuries, or certain acute illnesses.

Diagnosing the condition often involves checking the blood and urine for high levels of glucocorticoid. These tests involve obtaining urine at regular intervals for a period of 24 hours. They may also include obtaining blood plasma and saliva.

Key Symptoms

As with other conditions caused by another illness or disease, hypercortisolism can also have a variety of symptoms. Patients often complain of fatigue and muscle weakness. They also often experience mood swings due to depression. One of the most noticeable symptoms of the condition is unintentional weight gain.

Patients also often have high blood pressure and increased blood sugar levels. This makes them more prone to diabetes and osteoporosis. Some experience problems with their immune system, while others develop kidney stones or experience erectile dysfunction.

Other symptoms include excessive fat on the collarbone and/or at the back of the neck. Many patients also experience thinning hair and skin as well as excessive sweating. Some male patients suffer from baldness. Patients also complain of memory problems and trouble maintaining their focus.

Who to See & Types of Treatment Available

Patients who have not been diagnosed but showing symptoms listed above should consult a primary doctor. If hypercortisolism is suspected, the patient will be referred to a specialist.

The biggest problem with this condition is that it can be difficult to diagnose. Most of the time, doctors are only able to catch it when it has already progressed. This can be a problem because patients have a better prognosis if they receive prompt treatment.

During the assessment, the patient has to provide a list of all the medications that he or she is currently taking. The doctor will ask about his or her other illnesses that he or she is receiving treatment for. With the list of drugs and illnesses, doctors can determine possible causes of increased levels of cortisol.

A series of exams to determine the patient’s cortisol levels are then carried out. These include testing for cortisol in the urine, blood, and saliva. If test results indicate the presence of this condition, the patient will be referred to an endocrinologist.

An endocrinologist will also order similar tests to confirm the initial results. If the tests confirm high levels of cortisol, the doctor will find out the exact cause of hypercortisolism. This is important because the treatment of the condition is based on the underlying condition. If caused by drugs that the patient is taking, the doctor will slowly reduce the dosage or replace the drugs.

If the condition is caused by a tumour, treatment may include surgery, chemotherapy, or radiotherapy. In some cases, a combination of these treatment methods is required to effectively remove the abnormal growth. It is important to note that surgery may not be an option in some cases. The doctor may not be able to operate if the tumour is very close to vital organs. The same is the case if the patient is not well enough to undergo invasive procedures. In such events, treatment will focus on managing the symptoms instead of treating the condition itself.

References:

  • National Institutes of Health; “Cushing Syndrome: Condition Information”; https://www.nichd.nih.gov/health/topics/cushing/conditioninfo/Pages/default.aspx

  • US National Library of Medicine; “Cushing’s Syndrome: Also Called Hypercortisolism”; https://medlineplus.gov/cushingssyndrome.html#cat_92 Diapedia;”Hypercortisolism”; https://www.diapedia.org/other-types-of-diabetes-mellitus/4104279115/hypercortisolism

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