Hypercortisolism

Hypercortisolism describes a state of glucocorticoid excess and is categorized as exogenous (from the prolonged use of glucocorticoids) and endogenous (from adrenal cortisol overproduction). Signs and symptoms of cortisol excess include easy bruising, proximal muscle weakness, changes in fat distribution, striae, and facial plethora. The diagnosis of adrenal hypercortisolism is first established by biochemical studies, followed by a determination of ACTH-dependent vs independent disease. In patients with an adrenal nodule, various imaging studies are utilized to further guide management. Pharmacologic steroidogenesis inhibition can be used to manage the effects of cortisol excess as a bridge to surgery or in the setting of a non-localized or uncontrollable primary source. However, the mainstay of treatment for a benign, cortisol-secreting adrenal mass is minimally invasive adrenalectomy. Perioperative management in patients with adrenal hypercortisolism is critical and includes recognition of life-threatening adrenal insufficiency which can present with fatigue, hypotension, anorexia, syncope, or confusion.