Where does excess cortisol come from?
Cortisol is produced by the adrenal glands at the command of the hormone ACTH, which is secreted by the pituitary gland. Normally, cortisol levels are highest in the morning and lowest at night. The excess occurs in two scenarios. Exogenous - when a person receives glucocorticoids for a long time in therapeutic doses for autoimmune, skin, pulmonary and joint diseases. Endogenous - when the hormone produces a tumor: the pituitary adenoma secretes excess ACTH and stimulates both adrenal glands, or the tumor of the adrenal gland itself produces cortisol autonomously, or ACTH produces a tumor of another location.
- Exogenous hypercortisolism from taking hormones
- Itsenko-Cushing's disease - pituitary adenoma
- Adrenal tumor that produces cortisol
- Ectopic production of ACTH by a tumor of another location
- Bilateral adrenal hyperplasia
Symptoms
Appearance changes gradually, so relatives notice changes in old photographs. The face becomes round and purple, fat is deposited on the abdomen, between the shoulder blades and above the collarbones, while the arms and legs become thin due to muscle loss. The skin becomes thinner, bruises easily, and wide purple-purple stretch marks appear on the abdomen and thighs. High blood pressure, high sugar, osteoporosis with fractures are added, in women - cycle disorders and excess hair growth, in men - decreased libido. Characterized by mood swings, anxiety, and insomnia.
- Rounding and redness of the face
- Fat deposition on the trunk with thin limbs
- Wide purple stretch marks
- Muscle weakness, especially in the thighs
- High blood pressure and high sugar
- Bruises, poor wound healing
- Osteoporosis and fractures
- Cycle disturbances, excess hair growth
Diagnostics
First, the doctor must clarify whether the patient is taking glucocorticoids in any form, including ointments and injections into the joints. Then the fact of excess cortisol is confirmed: its level is determined in daily urine, in saliva late in the evening, and an overnight test with dexamethasone is performed. At least two positive tests are required because obesity, depression, alcohol and pregnancy have similar changes. After confirmation, ACTH is determined to understand the source: if the level is high, the pituitary gland is examined using MRI; if the level is low, the adrenal glands are examined using computed tomography.
- Clarification of glucocorticoid intake
- Cortisol in daily urine
- Cortisol in saliva late at night
- Night test with dexamethasone
- Blood ACTH
- MRI of the pituitary gland or CT scan of the adrenal glands
- Glucose, HbA1c, potassium, lipids, densitometry
Treatment
With the dosage form, the main task is to, together with the attending physician, select the minimum effective dose of the hormone or switch to another therapy. It is impossible to cancel glucocorticoids suddenly: this is dangerous due to adrenal insufficiency, the dose is reduced gradually according to the scheme. For pituitary adenoma, the main method is surgery through the nose to remove the tumor; for an adrenal tumor, removal of the affected adrenal gland. If surgery is impossible or not effective enough, drugs that suppress cortisol synthesis and radiation treatment are used. At the same time, blood pressure, diabetes, and osteoporosis are treated.
- Gradual reduction in the dose of glucocorticoids under the supervision of a physician
- Transnasal removal of pituitary adenoma
- Adrenal tumor removal
- Drugs that block cortisol synthesis
- Radiation therapy if surgery is ineffective
- Treatment of blood pressure, diabetes and osteoporosis
- Long-term observation by an endocrinologist after treatment
What happens after treatment
After successful tumor removal, cortisol levels drop sharply, and the body needs time to restore its own regulation. During this period, replacement therapy is prescribed, which is gradually withdrawn, sometimes over a year or longer. External changes do not go away immediately: the face and figure return to their previous appearance in a few months, stretch marks fade but remain, bone density is restored slowly. It is important to continue monitoring as the disease may return, as well as monitor blood pressure, sugar and bone health.
- Temporary replacement therapy after surgery
- Gradual restoration of appearance over months
- Residual pale stretch marks
- Control of blood pressure, sugar, lipids
- Densitometry and treatment of osteoporosis
- Regular cortisol monitoring to detect relapse
- Support for Anxiety and Depression