Pituitary Grand Rounds, episode three: disorders of cortisol secretion related to adrenal conditions

Dr. Blevins focuses on the diagnostic process of endogenous hypercortisolism by following a patient’s diagnosis and treatment process with hypercortisolism related to a functioning, cortisol-producing adrenal adenoma. It is particularly noteworthy that most people affected by this condition don’t have the overt features of Cushing’s syndrome.

Ana’s story highlights adrenal diseases and the fact that some people with high cortisol levels are going to look like the classic patient with hypercortisolism, with symptoms and signs but not the textbook picture of Cushing’s. It was Ana’s work to push forward to get a diagnosis and understand what was going on with her, which led to a diagnosis that might have been otherwise considerably delayed. Ana walks us through her struggle and her substantial emotional challenges, including mood changes, depression, and anxiety. Dr. Blevins walks us through Ana’s final diagnosis with a thorough clinical discussion, leading to an excellent discussion of cortisol levels affecting mental acuity and physical challenges.

We focus on this adrenal condition in our pituitary grand round series as more than 50% of the patients that Dr. Blevins sees with adrenal tumors that produce cortisol were originally referred with the incorrect suspicion of having a pituitary cause of Cushing syndrome.

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