Increased cortisol

Introduction Hypercortisolism, also known as Cushing's syndrome, is a disease caused by excessive secretion of glucocorticoids from the adrenal cortex. According to the etiology, it is divided into Cushing's disease (excessive secretion of ACTH in the pituitary), Cushing's syndrome (excessive secretion of glucocorticoids from the adrenal gland) and ectopic ACTH syndrome (ACTH from cancers outside the pituitary). Intrinsic is a clinical syndrome characterized by hypercortisolemia caused by multiple causes, mainly characterized by full moon face, multiple blood appearance, central obesity, hemorrhoids, purple lines, high blood pressure, secondary diabetes and Osteoporosis and so on.

Cause

Mainly due to hypothalamic-pituitary dysfunction or pituitary adenoma caused by bilateral adrenal hyperplasia, or the tumor of the adrenal gland itself excessive secretion of cortisol, resulting in excessive glucocorticoids in the body.

Glucocorticoids are secreted by the adrenal gland. The function of the adrenal gland is regulated by the pituitary gland, which is often caused by pituitary adenomas and adrenal adenomas (or carcinomas). The pituitary gland grows adenoma, and the secretion of ACTH increases, causing the adrenal cortex to proliferate and secrete excess hormone. Adrenal adenomas and cancer can also cause an increase in glucocorticoids. Other less common causes are ectopic ACTH spasm syndrome and drug-induced Cushing's syndrome caused by long-term use of large amounts of corticosteroids. Hypercortisolism is the most common form of adrenal hyperfunction. Excessive secretion of glucocorticoids (primarily cortisol) from the adrenal cortex causes metabolic disorders such as fat, sugar, protein and electrolytes:

1 promote the body's fat metabolism and fat redistribution, so that the fat tissue of the limbs mobilize decomposition, deposition in the trunk, gluconeogenesis, limb muscle atrophy, the formation of centripetal obesity.

2 Hepatic glycogen decomposition accelerates, glucose oxidation is inhibited, causing blood sugar to increase, impaired glucose tolerance, diabetes group and diabetes.

3 inhibits protein synthesis in the body, promotes the decomposition of proteins in the body, causes negative nitrogen balance in the body, and appears thin skin, multiple blood, purple lines, muscle atrophy and osteoporosis.

4 In addition to increased cortisol secretion in the adrenal cortex hormones, the secretion of ll-deoxycorticosterone and corticosterone with mineralocorticoids also increased, resulting in retention of sodium and water in the body, increased potassium and chloride excretion, causing hypertension, severe can occur Low potassium and low chlorine sputum poisoning.

In addition, due to excessive secretion of cortisol, causing a variety of organ dysfunction, resulting in a series of clinical syndromes.

an examination

Related inspection

Renal CT examination of adrenocorticotropic hormone (ACTH) dexamethasone inhibition test

(1) Clinical manifestations

Centripetal obesity

It is characterized by a full moon face, buffalo back, obese body and slender limbs, which are caused by abnormal distribution of fat caused by cortisol.

2. General malaise

As cortisol increases, protein breakdown increases, muscles shrink, and skin elastic fibers decrease. Osteoporosis causes the patient to be weak, slow to move, and has difficulty going upstairs. The patient's skin is crisp, the face is flushed, and the blood is changed. The skin has purple lines, especially in the abdomen, the thighs and buttocks are more common, the back is painful, and even pathological fractures occur.

3. Rough skin, hairy, acne, sexual dysfunction. Women may have reduced menstruation, low sexual function, and even masculinization. In men, there is loss of libido, impotence and testicular atrophy.

4. Cardiovascular system

90% of patients with hypertension in this disease may be related to the sensitivity of cortisol to arterial adrenaline and sodium retention. It is characterized by dizziness, headache, myocardial ischemia, cardiac insufficiency, heart failure, insufficient blood supply to the brain, and retinopathy.

5. Psychiatric symptoms are characterized by impatience, depression, apathy, dumbness and typical mental illness.

6. Impaired glucose tolerance.

7. Blood and electrolyte changes

White blood cells are higher, lymph and eosinophils are reduced. Normal or high blood sodium, blood potassium can be low.

(two) hormone quantitative examination

The blood cortisol content increased, the cortisol rhythm was abnormal, and the 24-hour urine 17-hydroxysteroid content increased.

(three) X-ray examination

X-ray film

Luguping tablets are routinely examined for the sella, and the long bones of the spine, ribs, pelvis and extremities have obvious decalcification, looseness and even pathological fractures.

2. Retroperitoneal angiography

It is helpful for the examination of adrenal hyperplasia, tumors, etc. Due to the wide application of B-ultrasound and CT, this test has been used sparingly.

3.CT

Can accurately understand the size of bilateral adrenal glands, the nature of the mass and its relationship with the surrounding organs.

(4) B-ultrasound

Similar to CT, it is also of great value in diagnosing this disease. Its image resolution is lower than that of CT, but its operation is simple, the scanning direction is flexible, and the price is low.

(5) Laboratory inspection

The white blood cell count is high, mainly due to increased multinucleated cells and decreased lymph and eosinophils. Blood chemistry can have elevated blood sodium, decreased blood potassium, urinary sputum, and impaired glucose tolerance curve.

(6) Dexamethasone inhibition test

After the diagnosis of cortisol, this test is helpful in identifying cases of cortical hyperplasia or cortical adenoma. If hyperplasia, after the application of dexamethasone, blood cortisol decreased significantly, such as cortical adenoma has no effect.

Differential diagnosis

Etiology identification

Identification of adrenal hyperplasia and tumors.

(1) ACTH stimulation test

ACTH 25 mg daily, intravenous infusion, maintained for 8 hours, two days after, in the case of cortical hyperplasia, urinary l-hydroxyl steroids increased significantly 24 hours after stimulation, about 7 to 7 times the base value; adenoma response It is weak; cancerous people are generally not stimulated by ACTH.

(2) High-dose dexamethasone inhibition test

Daily dexamethasone 8 mg (4 times orally) for two consecutive days. Urine l 7 hydroxysteroids can inhibit proliferation to less than 50% of the control value, while tumors are not inhibited.

2. Symptom identification

(1) Simple obesity

Obesity can be associated with essential hypertension, impaired glucose tolerance, rare menstruation or amenorrhea, and purple lines on the skin. Acne, hairy, 24-hour urine, 7-hydroxysteroids and 17-ketosteroids were higher than normal. Similar to hypercortisolism. But simple obesity has a uniform distribution of fat; no skin is thin and multi-blood changes; purple is mostly white, sometimes reddish, but generally fine; blood cortisol concentration is not high, normal circadian rhythm exists: small dose Most of the dexamethasone suppression test can be inhibited; the X-ray examination of the sella has no enlargement and no osteoporosis.

(2) Cranial plate hyperplasia is more common in women, clinical manifestations of obesity, hirsutism, hypertension and neuropsychiatric symptoms. Must be differentiated from hypercortisolism. The former obesity is more obvious in the trunk and limbs; the skull X-ray film shows the frontal bone and other intracranial plate hyperplasia, and there is no saddle enlargement and osteoporosis change, and there is no metabolic disorder caused by excessive cortisol secretion.

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