Cortisol is a steroid hormone produced by the adrenal glands in response to stress, affecting blood pressure, blood sugar and the immune system. Synthetic steroid drugs are available which are similar to cortisol and these are commonly used to treat diseases such as asthma. Sometimes a hormone-producing tumor in the body, or long-term use of steroid drugs, leads to the body being exposed to too much cortisol. This results in what is known as Cushing’s syndrome, where weight is gained on the face, chest and belly, and the skin becomes thin and fragile. Weak bones and muscles, tiredness and emotional changes, high blood pressure and menstrual irregularities may also occur.
Cushing’s syndrome is a rare condition in which elevated cortisol levels are most often caused by taking steroid medication for a chronic, or ongoing, disease. Another cause, which is less common, is a tumor growing inside the pituitary gland inside the brain, known as a pituitary adenoma. This tumor is not cancerous, but it produces what is called adrenocorticotropic hormone, or ACTH, which acts on the adrenal glands to make them produce cortisol. When high cortisol levels result from a pituitary adenoma, the condition is known as Cushing’s disease. Less often, tumors in the adrenal glands themselves, or tumors that produce ACTH in other parts of the body, can be the cause of too much cortisol.
The effects of having too much cortisol develop over time, and can vary according to the individual. It is common for the limbs to remain thin while fat collects around the torso and face, and the ankles may become swollen due to water retention. The face may take on a flushed appearance and, in women, facial hair may begin to grow. What is described as a buffalo hump is sometimes seen, with fat building up behind the neck and over the shoulders. The skin becomes easily bruised and stretch marks may develop.
Too much cortisol can lead to fatigue, aching and muscle weakness, with the shoulders, upper arm and upper leg muscles being most affected. The immune response becomes less efficient, with infections more likely to occur and spots and cuts taking longer to heal. In women, menstrual irregularities may develop or menstruation may stop completely.
High blood pressure, brittle bones and diabetes may all be associated with having too much cortisol. Cognitive problems and loss of libido may occur, with anxiety, depression and sleep problems developing or becoming worse. The treatment of Cushing’s syndrome is different for each cause, but could involve stopping steroid medication, taking drugs that block the action of cortisol, or removing hormone-producing tumors using surgery, radiotherapy or chemotherapy. With successful treatment, the effects of having too much cortisol in the body may be reversed.