High cortisol

Cortisol is a hormone that is located in the adrenal glands. However, cortisol often causes many problems. The symptoms of these problems on our human body are also different. These problems are mainly divided into high or low cortisol. There may still be many people who don’t know what kind of disease high cortisol is. So what exactly is high cortisol?

Cortisol, also known as hydrocortisone, hydrocortisone or compound F, is extracted from the adrenal cortex. It is the adrenal cortical hormone with the strongest effect on carbohydrate metabolism, that is, it is a type of glucocorticoid.

Cortisol is sometimes used to refer specifically to the basic "stress hormone." Cortisol is produced from 11-deoxycortisol by the action of 11β-hydroxylase in the mitochondria of the adrenal cortex. Cortisol can also be converted into cortisol through the action of 11-β-hydroxysteroid dehydrogenase (11-β-hydroxysteroid dehydrogenase).

Cushing's syndrome, also known as hypercortisolism, is mainly caused by hypothalamic-pituitary dysfunction or pituitary adenoma causing bilateral adrenal cortical hyperplasia, or tumors in the adrenal glands themselves causing excessive secretion of cortisol. The typical clinical syndrome is caused by metabolic disorders due to excessive cortisol, and its main manifestations include moon face, centripetal obesity, sanguinea, purple skin lines, increased blood sugar and blood pressure, osteoporosis, and reduced resistance to infection. This disease is more common in adult women. The ratio of males to females is 1:2.5. Through the low-dose dexamethasone suppression test and the changes in the circadian rhythm of cortisol secretion, the treatment plan is determined after localization and etiology diagnosis, and surgery, radiotherapy or drug treatment may be selected.

Clinical manifestations: 1. Obesity, centripetal distribution of fat, full moon face, thick fat on chest, abdomen, neck and back, thin skin, sanguineous texture, and purple skin lines;

2. Acne, hirsutism, menstrual disorders in women, impotence in men, low libido, and reduced resistance to infection;

3. Osteoporosis, which can easily cause spinal compression fractures;

4. Increased blood pressure, left ventricular hypertrophy and heart failure in patients with long-term illness;

5. Emotional instability, irritability, and even mental disorder.

Diagnostic basis: 1. Obesity, centripetal distribution of fat, full moon face, sanguineous constitution, purple skin lines, mood swings, irritability, acne, hirsutism, menstrual disorders in women, impotence in men, and reduced resistance to infection;

2. Osteoporosis, prone to spinal compression fractures;

3. Increased blood pressure, left ventricular hypertrophy and heart failure in patients with long-term illness;

4. Increased blood sugar and decreased glucose tolerance;

5. Increased red blood cells and hemoglobin, increased total white blood cell count and neutrophils, decreased lymphocytes and eosinophils;

6. Blood biochemistry shows low potassium and normal or high carbon dioxide binding rate;

7. Elevated urinary 17-hydroxycorticosteroids and 17-ketosteroids;

8. Increased urinary free cortisol and plasma cortisol;

9. In the low-dose dexamethasone suppression test, blood cortisol and urinary free cortisol are not suppressed below the control normal value;

10. Adrenal gland, CT, B-ultrasound, sella turcica X-ray, pituitary CT, MRI examinations can reveal corresponding lesions;

11. In normal adrenal hypercortisolism (adenoma or carcinoma), the high-dose dexamethasone test is not suppressed and the blood ACTH is lower than normal.

Treatment principles: 1. Surgical treatment; 2. Radiotherapy; 3. Drug therapy; 4. Symptomatic treatment.

Principles of medication: 1. For pituitary Cushing's disease and pituitary microadenoma (less than 10mm in diameter), transsphenoidal surgical removal is the first choice, which is expected to be a cure. If the pituitary microadenoma cannot be removed, one side of the adrenal gland can be removed, and most of the other side can be removed, followed by pituitary radiotherapy after surgery.

2. Adrenal Cushing's syndrome, that is, adrenal tumors and adenocarcinomas should be surgically removed and short-term hormone replacement therapy should be given.

Auxiliary examination: 1. The clinical symptoms and signs are typical, and the examination items are limited to the examination box "A";

2. If the clinical symptoms and signs are atypical, the examination items may include examination boxes "A" and "C".

Efficacy evaluation: 1. Cure: (1) Blood pressure drops to normal, menstruation resumes, and central obesity is reduced; (2) Blood electrolytes are normal, and blood sugar and glucose tolerance are normal; (3) Plasma cortisol, urinary 17-hydroxycorticosteroids, and urinary 17-ketosteroid levels are normal; (4) No recurrence within 5 years, and adrenal cortex function is normal.

2. Improvement: (1) Blood pressure decreases and symptoms improve; (2) Blood electrolyte and blood sugar levels are basically normal; (3) Plasma cortisol, urinary 17-hydroxycorticosteroids, and urinary 17-ketosteroid levels decrease.

3. Uncured: Symptoms and signs have not improved, laboratory tests are not normal, and localization tests show no change in the source of the disease.