Cortisol-Related Diseases

Here’s a comprehensive guide to the diseases and disorders associated with cortisol, both excess and deficiency — since cortisol levels must stay tightly regulated for the body to function properly.

Diseases Caused by Excess Cortisol

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

Adrenal Adenoma or Carcinoma

  • Tumors of the adrenal cortex may secrete cortisol autonomously
  • Part of Cushing’s syndrome

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

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)

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)

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/p>

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