🧪 Cortisol-Related Diseases
🔺 Diseases Caused by Excess Cortisol
1. Cushing’s Syndrome
- Cause: Chronic high cortisol levels — endogenous or exogenous
- Sources:
- Pituitary tumor (Cushing’s disease): excess ACTH
- Adrenal tumor: overproduction of cortisol
- Ectopic ACTH (e.g. small-cell lung carcinoma)
- Long-term steroid use (iatrogenic)
🩺 Symptoms:
- Weight gain (central obesity, “moon face”, “buffalo hump”)
- Thin skin, easy bruising, striae (purple stretch marks)
- Hypertension, hyperglycemia, insulin resistance
- Muscle wasting, osteoporosis
- Depression, anxiety, cognitive issues
- Irregular menses or hirsutism in women
2. Adrenal Adenoma or Carcinoma
- Tumors of the adrenal cortex may secrete cortisol autonomously
- Part of Cushing’s syndrome
3. Pseudo-Cushing’s Syndrome
- Mimics Cushing’s symptoms but due to:
- Chronic alcoholism
- Depression
- Obesity
- Stress
- Not caused by true pathological cortisol overproduction
🔻 Diseases Caused by Cortisol Deficiency
1. Addison’s Disease (Primary Adrenal Insufficiency)
- Autoimmune destruction of adrenal glands → ↓ cortisol & aldosterone
- High ACTH (due to feedback loop), leading to skin pigmentation
🩺 Symptoms:
- Fatigue, weight loss
- Hypotension, low blood glucose
- Salt craving, hyperkalemia, hyponatremia
- Nausea, abdominal pain
- Hyperpigmentation (especially gums, creases)
2. Secondary Adrenal Insufficiency
- Caused by pituitary failure (↓ ACTH)
- Can result from tumors, trauma, or long-term corticosteroid withdrawal
- No hyperpigmentation (ACTH is low)
- Aldosterone usually normal (regulated by RAAS, not ACTH)
3. Tertiary Adrenal Insufficiency
- From hypothalamic dysfunction (↓ CRH)
- Often seen after abrupt withdrawal of exogenous steroids (suppression of HPA axis)
🧠Other Disorders Linked to Cortisol Imbalance
| Disorder | Cortisol Role |
| Depression | Often shows dysregulated or high cortisol |
| Anxiety / PTSD | HPA axis disruption; cortisol levels may be high or low |
| Insomnia | Cortisol peaks at night can disrupt sleep |
| Metabolic Syndrome | Chronic cortisol excess → insulin resistance, abdominal obesity |
| Osteoporosis | Long-term cortisol excess weakens bones |
| Immune suppression | High cortisol reduces immune response, raises infection risk |
🧬 Cortisol Imbalance Summary
| Condition | Cortisol Level | ACTH Level | Common Symptoms |
| Cushing’s Disease | High | High | Central obesity, thin skin, striae |
| Adrenal Tumor | High | Low | Same as above, no ACTH increase |
| Addison’s Disease | Low | High | Fatigue, dark skin, salt craving |
| Secondary Adrenal Insufficiency | Low | Low | Weakness, low BP, pale skin |
| Iatrogenic (steroids) | Low (after withdrawal) | Low | Same as secondary AI |