Cortisol abnormalities can have various effects on the body. Elevated cortisol levels, often associated with chronic stress, may lead to weight gain, disrupted sleep, and impaired immune function. On the other hand, insufficient cortisol, as seen in conditions like Addison’s disease, can cause fatigue, low blood pressure, and electrolyte imbalances. Balancing cortisol is crucial for overall health, as it plays a role in metabolism, inflammation regulation, and stress response. Monitoring cortisol levels and addressing abnormalities is essential for maintaining a healthy endocrine system.

1. University of Chakwal , Pakistan

2. Abnormalities of Cortisol Hormone
Department of Zoology
Presented by: Noureen Shehzad
REG. NO: 20M-UOC/ZOL- 46
BS Zoology
Session 2020- 2024
Subject: Endocrinology
Submitted to :Dr Syeda Nadia Ahmad

3. • Introduction
• Hypercortisolism
(Cushing’s Syndrome)
• Cushing Syndrome
During Pregnancy
• Functional brain
alterations in Cushing’s
Syndrome
• Incidence
• Hypocortisolism
(Addison’s Disease)
Abnormalities of
Cortisol Hormone

4. Cortisol Hormone
• Cortisol is one of the major glucocorticoids
synthesized in the zona fasciculate of the adrenal
Cortex
• Cortisol is known as a stress hormone involved in
the response to physical and/or emotional stress
Function
• Regulating blood pressure
• Reducing the immune system’s inflammatory
response
• Converting carbohydrates, fats, and proteins into
energy
• Control sleep cycle ( Jones, C., & Gwenin, C.
(2021).
Figure no 1.1: Cortisol Hormone
https://images.app.goo.gl/NeEm2iuguc9
dJtJ26

5. Abnormalities of Cortisol
Hormone
Hypocortisolism
(Addison’s Disease)
Hypercortisolism
(Cushing’s Syndrome)

6. • Cushing’s syndrome is a disorder that occurs when your body
makes too much of the hormone cortisol over a long period of time
• Endogenous Cushing syndrome results from excessive production
of cortisol by adrenal glands . It may be
• ACTH-dependent
• ACTH-independent
• Exogenous Cushing syndrome occurs in people taking
glucocorticoid (also called corticosteroid, or steroid) hormones
(Reincke, M., & Fleseriu, M. (2023).
Hypercortisolism (Cushing’s Syndrome)

7. Figure no 1.2: HPA Axis
https://images.app.goo.gl/iiiH1s6jQ8Gx6qo48

8. Cushing Syndrome During
Pregnancy
• Cushing’s syndrome (CS) is rare
during pregnancy, probably
because hypercortisolism
induces infertility
• 200 cases have been reported in
the literature
• Early diagnosis and management
of CS during pregnancy are
important because of associated
fetal and maternal morbidity
Functional brain alterations in
Cushing’s syndrome
• Patients with CS have
impaired attention, working
memory, reading speed and
difficulties in decision making
• Glucocorticoid receptors are
expresses throughout the whole
brain in CS
• Mineralocorticoid receptors are
also expressed in the brain,
specifically in the limbic
system (Papakokkinou, E., &
Ragnarsson, O. (2023)).

9. Europe.
( 1.2 to 2.4
Million)
Korea Sweden
( 1.6 Million) (2 to 3per
Million)
United State
( 6.2 to 7.6 Million)
Incidence
Of Cushing
syndrome

10. Symptoms
• Pink or purple stretch marks on the stomach, hips, breasts and
underarms.
• Slow wound healing
• Acne
• Extreme tiredness
• Muscle weakness
• Depression, anxiety and irritability
• Moon Face
• Buffalo bump
• Sleeplessness

11. Figure no 1.3: Symptom of Cushing Syndrome
https://images.app.goo.gl/uDj5Bk9hns5WdvWh6

12. 1. Corticosteroids
• Prolonged use of corticosteroids medicine
• Excess production of corticosteroids by adrenal
cortex; in adrenal tumor
2. Tumor
3. Familial Cushing Syndrome
Causes
Pituitary Gland Tumor
Ectopic Tumor Figure no 1.4: Pituitary Tumor
https://images.app.goo.gl/aA7NxhwvVdeH6uyB8

13. Complication
•
• Bone loss, also called osteoporosis, which can
lead to broken bones
•High blood pressure, also called hypertension
(85%)
• Type 2 diabetes( 18% to 64%)
• Serious or multiple infections
• Loss of muscle mass and strength
( Jones, C., & Gwenin, C. (2021).
https://images.app.goo.gl/UpsLiNcA7XgNjFrY9

14. Urinary Test:
• In this test, you will collect your urine over a 24-hour
period. Higher than normal cortisol levels suggest
Cushing’s syndrome
Late-night Salivary Cortisol Test:
• This test measures the amount of cortisol in your saliva
in the late evening
Low-dose dexamethasone suppression test (LDDST):
• In this test, you will take a low dose of dexamethasone,
a type of glucocorticoid, usually around 11:00 p.m
( Reincke, M., & Fleseriu, M. (2023)
Diagnose

15. Treatment
• Surgery
• Adrenal tumor is removed by surgery
• Pituitary tumor can be removed by
Transsphenoidal surgery
• Radiation Therapy
• If surgery is not successful
• Medical Therapy
• Osilodrostat, levoketoconazole, metyrapone
are approved in different countries
(Reincke, M., & Fleseriu, M. (2023).
Figure no 1.5: Transsphenoidalsurgery
https://images.app.goo.gl/R48Nu4WHLRLEFmsW9

16. • Addison’s disease, is a condition
caused when the adrenal glands do not
produce sufficient hormones like
cortisol and aldosterone
• It can affect people of all ages and
sexes and can be fatal
• The incidence rate of AD is about 35 to
120 cases per million people
(Munir, S., Rodriguez, Q., (2020)
Hypercortisolism ( Addison Disease)
Figure no 1.6: AddisonDisease
https://images.app.goo.gl/iP8HGG9SsbqekM5n7

17. Symptoms
•Extreme fatigue
• Weight loss and loss of appetite
• Areas of darkened skin
• Low blood pressure, even fainting
• Salt craving
• Low blood sugar, also called hypoglycemia
• Nausea, diarrhea or vomiting
• Abdominal pain
• Muscle and joint pain
• Depression

18. 1. Primary adrenal insufficiency
• In an autoimmune disease, your body’s immune
system mistakes any organ or area of the body
for a virus, bacteria, or another outside invader
•Other causes of primary adrenal insufficiency
include:
•Prolonged administration of glucocorticoids
(e.g. prednisone)
• Infections in your body
• Cancer and abnormal growths (tumors)
• Certain blood thinners used to control clotting
in the blood
Causes
Figure no 1.8 : Primaryadrenal insufficiency
https://images.app.goo.gl/v4df5Hm8j2ZEo5mb9

19. 2. Secondary adrenal insufficiency
• There are also many causes of secondary
adrenal insufficiency, including:
• Tumors
• Medications
• Genetics
• Traumatic brain injury
Figure no 1.9: Secondary adrenal insufficiency
https://images.app.goo.gl/kXP8So6usy6pF5Q8A

20. 1. History Collection
2. Physical Test
3. Laboratory Tests
• Blood test
• Low serum sodium
• Normal sex hormone levels
• Abdominal X-ray and CT scans
• Blood eosinophils count, urine cortisol,
and other tests may be used as
confirmatory tools
Diagnose

21. Treatments
• Hormone replacement therapy is
used to correct the insufficient
level of steroids the adrenal
glands can not produce
• Increase Intake in sodium
• Life long drug maintenance is
required
• Meditation, yoga, and other
stress-relieving therapies can help
(Savas, M., Mehta, S., Agrawal.,et
al (2022).
Medication
• Hydrocortisone – these tablets
replace the missing cortisol
• Fludrocortisone – might be
prescribed for missing
aldosterone
• Dehydroepiandrosterone
(DHEA) – these pills may be
prescribed if there is an androgen
(the male sex hormone)
deficiency

22. • Papakokkinou, E., & Ragnarsson, O. (2023). Functional brain alterations in Cushing’s
syndrome. Frontiers in Endocrinology, 14, 1163482.
• Jones, C., & Gwenin, C. (2021). Cortisol level dysregulation and its prevalence—Is it
nature’s alarm clock?. Physiological reports, 8(24), e14644.
• Braun, L. T., Vogel, F., & Reincke, M. (2022). Long‐term morbidity and mortality in
patients with Cushing’s syndrome. Journal of Neuroendocrinology, 34(8), e13113.
• Reincke, M., & Fleseriu, M. (2023). Cushing Syndrome: A Review. JAMA, 330(2), 170-
181.
• Savas, M., Mehta, S., Agrawal, N., van Rossum, E. F., & Feelders, R. A. (2022).
Approach to the patient: diagnosis of Cushing syndrome. The Journal of Clinical
Endocrinology & Metabolism, 107(11), 3162-3174.
• Munir, S., Rodriguez, Q., & Waseem, M. (2019). Addison disease
References

23. Thank you