Primary Hypercortisolism

Primary hypercortisolism, better known as Cushing's syndrome, describes an excess of cortisol, a steroid the adrenal gland secretes. The disorder causes obesity and numerous other issues, but doctors often treat it easily by changing patients' medication.

Primary vs Secondary

• Primary hypercortisolism features high levels of cortisol but normal levels of ACTH, the hormone that stimulates its production. This distinguishes Cushing's syndrome from Cushing's disease, secondary hypercortisolism, in which a tumor secretes extra ACTH.

Causes

• The adrenal glands may produce excess cortisol because they overreact to ACTH. Usually though, hormone treatment causes primary hypercortisolism. Steroids treat diseases like rheumatoid arthritis, and some of these steroids can cause hypercortisolism.

Symptoms

• Sufferers quickly gain weight, sweat a lot, bruise easily and experience acne. They grow extra facial hair and lose hair on their heads. Excess cortisol also sometimes disrupts other hormonal cycles, leading to emotional problems and impotence or infertility.

Diagnosis

• Doctors measure cortisol in urine as an initial test. If they detect excess cortisol, they test other hormone levels. They then test for tumors on the adrenal and pituitary glands with MRI and CT scans.

Treatment

• Steroid use causes most primary hypercortisolism, so patients treat the disease simply by stopping taking steroids. Doctors sometimes though must remove the adrenals, and the patient starts taking steroids to replace them.