Cortisol functions and disorders

What are the primary functions of cortisol in the body?, How do disorders of cortisol regulation such as Addison’s disease and Cushing’s syndrome manifest clinically?

Cortisol: Functions and Disorders

Functions of Cortisol

Metabolism Regulation: Increases gluconeogenesis, lipolysis, and protein catabolism to maintain blood glucose levels.
Immune Suppression: Reduces inflammation and suppresses immune response by inhibiting cytokine production.
Stress Response: Part of the hypothalamic-pituitary-adrenal (HPA) axis; increases energy availability during stress.
Blood Pressure Regulation: Enhances vasoconstriction by increasing sensitivity to catecholamines.
Electrolyte Balance: Influences sodium and water retention, while promoting potassium excretion.

Addison’s Disease (Cortisol Deficiency)

Causes: Autoimmune destruction (primary), pituitary dysfunction (secondary), long-term steroid withdrawal.
Symptoms: Fatigue, weight loss, hyperpigmentation (primary), low blood pressure, salt cravings, nausea, and hypoglycemia.
Diagnosis: Low cortisol and aldosterone levels, high ACTH in primary Addison’s, abnormal ACTH stimulation test.
Treatment: Lifelong corticosteroid replacement (hydrocortisone), mineralocorticoid replacement (fludrocortisone for primary cases).

Cushing’s Syndrome (Excess Cortisol)

Causes: Pituitary adenoma (Cushing’s disease), adrenal tumors, prolonged corticosteroid use.
Symptoms: Central obesity, moon face, buffalo hump, muscle weakness, osteoporosis, hyperglycemia, hypertension, thin skin, purple striae.
Diagnosis: Elevated cortisol levels (24-hour urinary cortisol, dexamethasone suppression test), abnormal ACTH levels.
Treatment: Tumor removal (if present), gradual tapering of corticosteroids, medications (ketoconazole, metyrapone) to inhibit cortisol production.

Long-Term Management Considerations

Regular monitoring: Adjust levothyroxine or ATD doses based on lab results.
Nutritional factors:
- Iodine-rich diet (for deficiency prevention).
- Avoid excess iodine in hyperthyroidism.
Lifestyle modifications:
- Manage stress, maintain a balanced diet, exercise.
- Monitor bone health in hyperthyroid patients (risk of osteoporosis).

Thyroid disorders require lifelong management, with early diagnosis and treatment essential for preventing complications.

Conclusion

Cortisol is essential for homeostasis, metabolism, and stress adaptation. Disorders of cortisol regulation require early diagnosis and treatment to prevent severe complications such as adrenal crisis in Addison’s disease or cardiovascular risks in Cushing’s syndrome. APA