Adrenocorticotropic hormone (ACTH)-independent hypercortisolism (cortisol-secreting adrenal adenoma or hyperplasia)
Cortisol fluctuations in patients with adrenal adenomas2
Types of Hypercortisolism
THERE ARE 2 TYPES OF HYPERCORTISOLISM: ACTH-INDEPENDENT AND ACTH-DEPENDENT1
Both types of hypercortisolism are characterized by a loss of the normal diurnal rhythm of cortisol.
| ACTH-INDEPENDENT HYPERCORTISOLISM IS Characterized by a gradual onset, progression, and worsening of signs and symptoms | |||
|---|---|---|---|
| Cortisol production | Autonomous secretion of excess cortisol1 | ||
| Cortisol levels | Normal to slightly elevated1 | ||
| ACTH levels | Suppressed or lower limit of normal3 | ||
| DHEA-S levels | Low-normal or suppressed4 | ||
| Signs and features | Patients typically do not display phenotypic features specific to the disorder5 | ||
| Associated conditions | Type 2 diabetes (T2D), bone fragility, hypertension, obesity, dyslipidemia, mood disorders6 | ||
Hear from patients who have ACTH-independent hypercortisolism
Nicole, age 26
Diagnosed with multiple syndromes/disorders prior to hypercortisolism diagnosis
Pat, age 69
Weight gain, mood swings, and multiple comorbidities lead to a hypercortisolism diagnosis
ACTH-dependent hypercortisolism (pituitary or ectopic tumor)
CORTISOL FLUCTUATIONS IN PATIENTS WITH PITUITARY ADENOMAS7
| ACTH-DEPENDENT HYPERCORTISOLISM IS CHARACTERIZED BY A MORE RAPID ONSET, PROGRESSION, AND WORSENING OF SIGNS AND SYMPTOMS | |||
|---|---|---|---|
| Cortisol production | Significantly elevated secretion of cortisol1 | ||
| Cortisol levels | Upper limit of normal or high1 | ||
| ACTH levels | Upper limit of normal to high3 | ||
| DHEA-S levels | Often elevated, since DHEA-S is stimulated by excess ACTH4 | ||
| Signs and features | Patients typically display phenotypic features that are disorder-specific1 • Facial fullness • Buffalo hump • Striae • Obesity | ||
| Associated conditions | T2D, bone fragility, hypertension, obesity, dyslipidemia, mood disorders6 | ||
Hear from patients who have ACTH-dependent hypercortisolism
Jenny, age 33
Being treated for the symptoms of hypercortisolism and considering transsphenoidal surgery
Charsetta, age 47
Overt Cushingoid symptoms and multiple pituitary adenomas led to a hypercortisolism diagnosis
References
1. Guaraldi F, Salvatori R. J Am Board Fam Med. 2012;25(2):199-208. doi:10.3122/jabfm.2012.02.110227 2. van Aken MO, Pereira AM, van Thiel SW, et al. J Clin Endocrinol Metab. 2005;90(3):1570-1577. doi:10.1210/jc.2004-1281 3. Debono M, Newell-Price JD. Front Horm Res. 2016;46:15-27. doi:10.1159/000443861 4. Chiodini I, Ramos-Rivera A, Marcus AO, Yau H. J Endocr Soc. 2019;3(5):1097-1109. doi:10.1210/js.2018-00382 5. Di Dalmazi G, Vicennati V, Garelli S, Casadio E, et al. Lancet Diabetes Endocrinol. 2014;2(5):396-405. doi:10.1016/S2213-8587(13)70211-0 6. Favero V, Cremaschi A, Parazzoli C, et al. P Int J Mol Sci. 2022;23(2):673. doi:10.3390/ijms23020673 7. Oster H, Challet E, Ott V, Arvat E, et al. Endocr Rev. 2017;38(1):3-45. doi:10.1210/er.2015-1080 8. Chiodini I, Torlontano M, Scillitani A, et al. Eur J Endocrinol. 2005;153(6):837-844. doi:10.1530/eje.1.02045 9. Catargi B, Rigalleau V, Poussin A, et al. J Clin Endocrinol Metab. 2003;88(12):5808-5813. doi:10.1210/jc.2003-030254 10. Costa DS, Conceição FL, Leite NC, Ferreira MT, Salles GF, Cardoso CR. J Diabetes Complications. 2016;30(6):1032-1038. doi:10.1016/j.jdiacomp.2016.05.006