Hyperadrenocorticism
Hyperadrenocorticism is a condition in which the body produces too much of the hormone cortisol over an extended period, leading to a range of physical and emotional symptoms that can significantly impact daily life and overall health.
Table of contents
- What Is Hyperadrenocorticism?
- Other Names for This Condition
- What Causes Hyperadrenocorticism?
- Who Is Affected?
- Signs and Symptoms
- Parts of the Body Involved
- How Is It Diagnosed?
- Treatment Options
- Possible Complications
- Living with Hyperadrenocorticism
What Is Hyperadrenocorticism?
Hyperadrenocorticism is a disorder that happens when your body has too much of the hormone cortisol, which is sometimes called the “stress hormone,” over a long period of time. Cortisol is a vital hormone that helps your body respond to stress, maintain blood pressure, regulate blood sugar, reduce inflammation, and turn food into energy.[1][3]
The condition occurs when this careful balance is disrupted. Normally, the adrenal glands (two small glands on top of your kidneys) make cortisol in response to signals from the pituitary gland in your brain. The pituitary produces a hormone called adrenocorticotropic hormone (ACTH) that tells the adrenal glands to release cortisol. When enough cortisol is present, the adrenal glands signal back to the pituitary to stop producing ACTH. In hyperadrenocorticism, this feedback system doesn’t work properly, and cortisol levels remain high all the time.[6]
Other Names for This Condition
Cushing’s syndrome, Cushing syndrome, hypercortisolism
What Causes Hyperadrenocorticism?
Hyperadrenocorticism can develop in two main ways, described as endogenous (from within the body) or exogenous (from outside sources).[6]
The most common cause of hyperadrenocorticism is taking medicines called glucocorticoids (such as prednisone or hydrocortisone) for a long time. These medications are used to treat various conditions like asthma, rheumatoid arthritis, and other autoimmune diseases, but they affect the body the same way as cortisol.[1][6][7]
When the body itself produces too much cortisol, the cause is usually a tumor. A small, non-cancerous growth in the pituitary gland can cause the gland to produce too much ACTH, which then signals the adrenal glands to make excess cortisol. This specific form is called Cushing’s disease and accounts for more than 70% of cases in adults and about 60% to 70% of cases in children and adolescents.[6][7]
Less commonly, a tumor can develop in one of the adrenal glands itself. This tumor may be benign (non-cancerous) or malignant (cancerous), and it produces too much cortisol without responding to signals from the pituitary gland. In rare cases, tumors in other parts of the body may also produce hormones that cause excess cortisol production.[6][7]
Who Is Affected?
Hyperadrenocorticism is a rare condition. Estimates suggest it affects about 40 to 70 people out of every 1 million.[3][6]
The condition most often affects adults between the ages of 25 and 50, though it can also occur in children.[3][6] Women are affected about three times as often as men, with some sources indicating that approximately 70% of people with hyperadrenocorticism are women.[3][6]
People who take glucocorticoid medications are especially vulnerable to developing hyperadrenocorticism. More than 10 million Americans take these medicines each year, though it’s not known exactly how many develop the condition.[3]
People with type 2 diabetes who have blood sugar levels that stay too high over time, along with high blood pressure, may have hyperadrenocorticism as an underlying cause.[3]
Signs and Symptoms
The symptoms of hyperadrenocorticism often develop gradually and can vary in intensity from person to person. Too much cortisol affects many parts of the body, leading to a wide range of symptoms.[1]
Common physical symptoms include unexpected weight gain, particularly around the face, neck, upper back, and midsection. This may create a rounded, moon-shaped face and a fatty deposit between the shoulders sometimes called a “buffalo hump.” At the same time, the arms and legs may appear thin.[1][6]
Skin changes are also very common. These include thin, fragile skin that bruises easily, pink or purple stretch marks on the stomach, hips, thighs, breasts, and underarms, acne, and wounds that heal slowly.[1][6][7]
Muscle weakness, particularly in the upper arms and legs, is another frequent symptom. Many people also experience fatigue and feel tired even after rest.[1][6]
Other physical symptoms can include high blood pressure, increased thirst and urination, excessive sweating, back pain, bone pain, and a higher number of infections.[1][6][7]
Women with hyperadrenocorticism may experience irregular menstrual periods or periods that stop completely. They may also develop thick, dark hair on the face and body, a condition called hirsutism.[1] Men may experience erectile dysfunction and low sex drive.[6][7]
Hyperadrenocorticism doesn’t just affect the body—it can also impact emotional and mental well-being. The hormone imbalance can contribute to mood swings, anxiety, irritability, and depression. Some people may also experience memory problems or difficulty concentrating.[6][14]
In children, the main symptoms are obesity and being short for their age.[7]
Parts of the Body Involved
- Adrenal glands
- Pituitary gland
- Hypothalamus
- Kidneys
- Brain
How Is It Diagnosed?
Diagnosing hyperadrenocorticism can be a complex and lengthy process because other illnesses can have similar symptoms. If you’re taking glucocorticoid medicines, your healthcare provider can review all your medications—including pills, injections, creams, and inhalers—to see if they could be causing the condition. If so, you may not need additional tests.[8]
When the condition is caused by the body making too much cortisol, you’ll need to see a doctor who specializes in hormonal diseases, called an endocrinologist. The endocrinologist will likely perform a physical exam looking for characteristic signs such as a round face, a hump on the back of the neck, thin skin with bruises, and stretch marks.[8][15]
Several tests may be used to measure cortisol levels and confirm the diagnosis. Urine tests may require you to collect your urine over a 24-hour period to measure cortisol and other hormone levels. Blood tests measure hormone levels at specific times, as cortisol levels normally rise and fall during the day—in people without hyperadrenocorticism, cortisol drops in the evening. A saliva test collected at night can check if cortisol levels remain too high when they should be low.[8][15]
Once hyperadrenocorticism is confirmed, imaging tests such as CT scans or MRI scans can take pictures of the pituitary and adrenal glands to look for tumors or other abnormalities.[8][15]
Treatment Options
Treatment for hyperadrenocorticism depends on what’s causing it and how severe the symptoms are. The sooner treatment starts, the better the chances for recovery.[1]
If the condition is caused by taking steroid medicines, treatment involves gradually reducing the dose of medication under careful medical supervision. It’s very important not to stop taking these medicines suddenly, as doing so can make you seriously unwell.[7][8]
When hyperadrenocorticism is caused by a tumor or overactive glands, several treatment options are available. Medicines can be prescribed to control the amount of cortisol the adrenal glands produce. Surgery may be performed to remove a tumor in the pituitary gland or adrenal glands. In some cases, radiation therapy may be used to treat a tumor in the pituitary gland. If the adrenal glands must be removed, you’ll need to take medicines for the rest of your life to replace the hormones they normally produce.[7][8]
After treatment, your cortisol levels will be monitored regularly. If levels remain high, you may need further treatment.[7]
Possible Complications
Without treatment, hyperadrenocorticism can be fatal and lead to serious health problems.[6]
Common complications include high blood pressure and high cholesterol. The condition can cause or worsen type 2 diabetes, prediabetes, or problems with blood sugar control.[3][6]
Hyperadrenocorticism weakens bones, leading to a condition called osteoporosis and an increased risk of broken bones. It also increases the risk of infections because the immune system doesn’t work as well.[3][6]
Dangerous blood clots can form, especially in the lungs and legs. The condition can also lead to heart problems, including heart attack and congestive heart failure.[6]
Mental health complications such as depression are also possible. Some people may experience memory problems or difficulty concentrating.[6]
Living with Hyperadrenocorticism
Living with hyperadrenocorticism can be challenging, especially on days when symptoms are more severe. Understanding how to adapt your daily habits and routines can help you feel more in control and support your overall well-being.[14]
Taking care of yourself can become difficult when symptoms like extreme fatigue or dizziness make even basic tasks feel overwhelming. It’s important to prepare for these difficult days by keeping essential items within easy reach and creating routines that work for you.[16]
Many people with hyperadrenocorticism benefit from reaching out to friends or family members when they’re having a hard day. Knowing that someone is aware of how you’re feeling can provide comfort and support. Some people also find help through support groups or online communities where they can connect with others facing similar challenges.[16][17]
Coping strategies can have a strong impact on quality of life. Learning how to talk with others about your condition, asking for what you need, and managing others’ reactions are all important skills. It’s also important to work through any feelings of anger or resentment that may develop over time.[17]
Even after successful treatment, many people continue to experience ongoing symptoms such as fatigue and pain. If your doctors feel they have done all they can to help but you’re still struggling, it’s important to know you’re not alone and to seek support for both physical and emotional challenges.[17]
