Hypercortisolism

Hypercortisolism, also known as Cushing's syndrome, is a medical condition characterized by an excess of cortisol in the body. Cortisol is a hormone produced by the adrenal gland that plays a vital role in various bodily functions, such as regulating blood sugar levels, aiding in metabolism, and helping the body respond to stress.

Causes

Hypercortisolism can be caused by a variety of factors, including:

• Prolonged use of corticosteroid medications, such as prednisone
• A benign tumor on the pituitary gland, known as a pituitary adenoma, which produces excess adrenocorticotropic hormone (ACTH)
• A malignant tumor on the adrenal gland or elsewhere in the body that produces excess cortisol
• Familial Cushing's syndrome, a rare genetic disorder that affects the regulation of cortisol production
• Other rare causes, such as ectopic ACTH-producing tumors or primary pigmented nodular adrenocortical disease (PPNAD)

Symptoms

The symptoms of hypercortisolism can vary depending on the severity and duration of the condition. Common symptoms include:

• Weight gain, particularly in the midsection of the body
• Thin, fragile skin that bruises easily
• Purple or pink stretch marks on the abdomen, thighs, or buttocks
• Mood changes, such as anxiety, depression, or irritability
• High blood pressure
• Glucose intolerance or diabetes
• Hirsutism (excess hair growth) in women
• Irrregular menstrual periods in women
• Erectile dysfunction in men

Diagnosis

Diagnosing hypercortisolism typically involves a combination of physical examination, medical history, and laboratory tests. These may include:

• 24-hour urine free cortisol test to measure the level of cortisol in the urine
• Salivary cortisol test to measure the level of cortisol in the saliva
• Blood tests to measure the levels of cortisol, ACTH, and other hormones
• Imaging studies, such as computed tomography (CT) or magnetic resonance imaging (MRI), to visualize the adrenal glands and pituitary gland

Treatment

Treatment for hypercortisolism depends on the underlying cause of the condition. Options may include:

• Discontinuing or reducing corticosteroid medications
• Surgery to remove a tumor on the pituitary gland or adrenal gland
• Radiation therapy to treat a tumor that cannot be surgically removed
• Medications to reduce cortisol production, such as ketoconazole or metyrapone
• Medications to manage symptoms, such as high blood pressure or glucose intolerance

Prognosis

The prognosis for hypercortisolism varies depending on the underlying cause and the effectiveness of treatment. With proper treatment, it is possible to control the symptoms of hypercortisolism and prevent long-term complications, such as osteoporosis, diabetes, and cardiovascular disease.