Adrenal Cortical Hyperfunction
Cushing’s Disease
Excess adrenocortical hormone production is known as Cushing’s disease.
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Cushing’s Disease Symptoms
In full-blown Cushing’s signs and symptoms include:
- Redistribution of fat to face (moon facies), truncal obesity, dorsal and supracalvicular fat pads
- Hypertension
- Osteoporosis and connective tissue weakness
- Insulin Resistance
- Decreased immunity
- Mood disturbances (depression, mania, anxiety)
- Poor wound healing
- Virilism in women
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Tests
Cushing’s can also be diagnosed by laboratory testing. Values found in Cushing’s would include elevated serum or 24-hour cortisol, elevated serum sodium, low serum potassium, and lowered eosinophil levels. Several tests, such as a dexamethasone suppression test, metyrapone test, and CRH test, can help differentiate primary from secondary (pituitary mediated) disease. Imaging studies can help to identify the presence of pituitary tumors that are the most common cause of secondary Cushing’s.
Hypercortisolism
As with Addison’s disease and adrenal insufficiency, Cushing’s disease can be seen to exist as a continuum. Cortisol is normally released in response to any stress, such as physical, psychological, infection or trauma. Since cortisol levels are usually not reduced until the stressor is removed, many people are suffering from a chronic form of low-level Cushing’s called hypercortisolism.
Symptoms
Symptoms of chronic hypercortisolism may include some of the symptoms of Cushing’s given above, as well as:
Cardiovascular: EKG abnormalities and myocardial hypertrophy correlate with high levels of serum cortisol. This is a mechanism by which stress can be an etiology for heart disease. Prolonged stress results in increased secretion of glucorticoids and maladaption of the Adrenal cortex to stress, which may result in adrenal corticohypertrophy.
Aging: High levels of cortisol from stress have been shown to accelerate the aging process in laboratory animals, but overall the basic rhythm of corticosteroid secretion is preserved in healthy individuals even in old age. However, older patients under stress are more prone to irregularities of circadian rhythm than their younger counterparts. This tends to further accelerates the aging process.6
Depression: The disruption of the circadian rhythm and high serum cortisol levels have been found to co-exist in depressed patients. There is a strong correlation between cortisol rhythm and diurnal mood variation in both depressed and healthy individuals. Cortisol levels thus have a profound effect on mood, and high levels have been associated with psychiatric disturbances, including depression, bipolar, and schizophrenia.(7-8)
Immune Function: T-lymphocytes serve as regulators of antigen-specific responses and are decreased with excess cortisol secretion. Cortisol also acts as an anti-inflammatory, down regulating interferon and ILK-2, causing a strong immunosuppression effect. Thus, hypercortisolism has been linked to immunosuppression.(9)
Insomnia: Deep sleep associated with REM occurs primarily when cortisol levels are decreased. Insomnia is associated with increased plasma cortisol. This is an important link in patients suffering from poor sleep and insomnia.(10-11)
Fatigue: Chronic and continual oversecretion of cortisol over time can weaken the adrenal glands and trigger exhaustion. Chronic Fatigue Syndrome (CFS) is diagnosed by consistent, debilitating fatigue for more than 6 months in absence of other definable causes. It is associated with depression, weight loss, an inability to handle stress and hypotension. Low cortisol levels and immune suppression have been found in most CFS patients.(12)
Other: High cortisol is also found in anorexia nervosa.(13) High levels can suppress thyroid function leading to hypothyroidism and other related illnesses.14 Excess cortisol production can also lead to a deficiency of progestin and estradiol. This can result in gynecological problems such as irregular periods and PMS.(15)
