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Harmful effects of functional hypercortisolism: a working hypothesis.

Giacomo Tirabassi1, Marco Boscaro, Giorgio Arnaldi

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Functional hypercortisolism (FH), a state of chronic stress hormone activation, is linked to various conditions. This review explores its potential negative health impacts, particularly metabolic and cardiovascular complications.

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Area of Science:

  • Endocrinology
  • Internal Medicine
  • Psychiatry

Background:

  • Functional hypercortisolism (FH) involves chronic activation of the hypothalamic-pituitary-adrenal axis.
  • It is associated with conditions like depression, eating disorders, alcoholism, obesity, and sleep apnea.
  • FH shares clinical and biochemical features with Cushing's syndrome, often presenting as pseudo-Cushing disease.

Purpose of the Study:

  • To review the emerging evidence on the negative role of functional hypercortisolism.
  • To discuss the systemic complications mediated by this hormonal imbalance.

Main Methods:

  • Literature review of studies investigating functional hypercortisolism and its associated conditions.
  • Analysis of clinical and biochemical findings related to hypercortisolism.

Main Results:

  • Functional hypercortisolism is prevalent in numerous chronic diseases.
  • It can lead to objective signs attributed to excess cortisol, such as striae and obesity.
  • The metabolic and cardiovascular complications of FH mirror those seen in Cushing's syndrome.

Conclusions:

  • Functional hypercortisolism, despite being reversible and mild, may contribute to significant health issues.
  • Understanding FH is crucial for managing associated metabolic and cardiovascular risks.