Adrenocorticotropic hormone (ACTH)-independent hypercortisolism (cortisol-secreting adrenal adenoma or hyperplasia)
Cortisol fluctuations in people 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.2
| 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 | ||
| DHEAS levels | Low-normal or suppressed4 | ||
| Signs and features | People 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 people 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 PEOPLE 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 | ||
| DHEAS levels | Often elevated, since DHEAS is stimulated by excess ACTH4 | ||
| Signs and features | People typically display phenotypic features that are disorder-specific1 • Facial fullness • Buffalo hump • Striae • Obesity | ||
| Associated conditions | T2D, bone fragility, hypertension, obesity, dyslipidemia, mood disorders6 | ||
Consider The Suspected Source Of Excess Cortisol
A significant proportion of people with hypercortisolism presenting initially with type 2 diabetes (T2D) will have an adrenal source8-11—it is important to select an initial screening test with sensitivity to detect all etiologies of hypercortisolism.
A majority of people with hypercortisolism presenting with T2D have an adrenal source of hypercortisolism8-11
Adrenal source of hypercortisolism
Hear from people 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
Nearly 1 in 4 people with difficult-to-control T2D had endogenous hypercortisolism12
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, 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. Steffensen C, Pereira AM, Dekkers OM, Jørgensen JO. Eur J Endocrinol. 2016;175(6):R247-R253. doi:10.1530/EJE-16-0434 11. Giovanelli L, Aresta C, Favero V, et al. J Endocrinol Invest. 2021;44(8):1581-1596. doi:10.1007/s40618-020-01484-2 12. Buse JB, Kahn SE, Aroda VR, et al. Prevalence of hypercortisolism in patients with difficult-to-control type 2 diabetes: updated results from CATALYST part 1 [symposium]. Presented by Fonseca, V. at the 22nd World Congress Insulin Resistance Diabetes & Cardiovascular Disease; December 12-14, 2024; Los Angeles, CA. 13. DeFronzo RA, Auchus RJ, Bancos I, et al. BMJ Open. 2024;14(7):e081121. doi:10.1136/bmjopen-2023-081121