Addison's Disease vs Cushing Syndrome, carbohydrates and Psychological Symptoms

1. Addison’s Disease vs. Cushing’s Syndrome

   Both Addison's disease and Cushing’s syndrome involve the adrenal glands but represent opposite ends of the cortisol spectrum.

   1. Adrenal Gland Involvement

2. Addison’s Disease (Adrenal Insufficiency):

   • Characterized by underproduction of cortisol (and often aldosterone).

   • Common causes include autoimmune destruction, infections (e.g., tuberculosis), or genetic disorders.

   • Primary adrenal insufficiency may also cause hypercalcaemia, likely due to volume depletion and reduced renal calcium excretion.

3. Cushing’s Syndrome:

   • Defined by overproduction of cortisol.

   • Causes include pituitary tumors (Cushing’s disease), adrenal tumors, or prolonged use of corticosteroids (iatrogenic Cushing’s).
     

2. Hormonal Imbalance and Physical Manifestations

Feature	Addison’s Disease	Cushing’s Syndrome
Cortisol Levels	Low	High
Aldosterone	Often low	Normal or suppressed
Weight Changes	Weight loss	Weight gain (especially central obesity)
Blood Pressure	Low (hypotension)	High (hypertension)
Skin Changes	Hyperpigmentation	Thin skin, easy bruising, purple striae
Electrolyte Changes	Hyponatremia, hyperkalemia	Hypokalemia, hyperglycemia
Treatment	Hormone replacement (hydrocortisone, fludrocortisone)	Tumor removal, reduce steroid use, medications

3. Psychological Symptoms

Addison’s Disease:

• Depression, apathy, and anxiety due to cortisol deficiency.

• Irritability and cognitive impairment (difficulty concentrating, poor memory).

• Psychosis can occur during adrenal crises (rare but serious).

Cushing’s Syndrome:

• Mood swings, anxiety, irritability, and aggression.

• Insomnia and cognitive problems (memory and concentration issues).

• Psychiatric symptoms such as mania, paranoia, and psychosis are more likely in severe or untreated cases.

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4. Metabolic and Carbohydrate Effects

Cushing’s Syndrome and Carbohydrates:

• Excess cortisol increases gluconeogenesis (glucose production).

• Associated with:

  • Insulin resistance

  • Glucose intolerance

  • Central obesity

  • Higher risk of type 2 diabetes

• High-carbohydrate diets, especially those rich in refined sugars, can worsen metabolic symptoms.

Addison’s Disease:

• Cortisol deficiency can cause low blood sugar and reduced stress tolerance, but it is not typically linked to carbohydrate metabolism dysfunction unless during adrenal crises.

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Hypercalcaemia in Adrenal Disorders

• Hypercalcaemia (high blood calcium levels) can occur in Addison’s disease, though it’s rare.

• Possible mechanisms:

  • Reduced renal calcium excretion

  • Volume depletion leading to hemoconcentration

• Not caused by hard water, which does not typically affect blood calcium levels.

Symptoms of Hypercalcaemia:

• Nausea, vomiting, constipation

• Thirst, frequent urination

• Muscle weakness

• Fatigue or confusion

• Bone pain, fractures

Reference: Penn Medicine - Hypercalcemia

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Diagnosis of Cushing’s Syndrome

Why the Dexamethasone Suppression Test is Important:

• Dexamethasone suppresses cortisol production in healthy individuals.

• In Cushing’s syndrome, cortisol remains high after dexamethasone administration, indicating a regulatory problem.

Additional Diagnostic Tests:

• 24-hour urinary free cortisol

• Late-night salivary cortisol

• Serum ACTH levels

• Imaging (CT/MRI of adrenal/pituitary glands)

• Inferior petrosal sinus sampling (to localize ACTH source)

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Glucocorticoids – What Are They?

• Glucocorticoids are a class of steroid hormones produced by the adrenal cortex.

• Their main functions:

  • Regulate metabolism (especially glucose metabolism)

  • Suppress inflammation

  • Help the body respond to stress

• Cortisol is the primary natural glucocorticoid in humans.

• Synthetic glucocorticoids (e.g., dexamethasone, prednisone) are used to treat inflammatory and autoimmune conditions but can cause Cushing’s syndrome if overused.

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In Summary

Category	Addison’s Disease	Cushing’s Syndrome
Cause	Adrenal gland destruction, autoimmune, infections	Cortisol overproduction (tumors, steroids)
Hormone Levels	Low cortisol, aldosterone	High cortisol
Key Symptoms	Fatigue, weight loss, low BP, hyperpigmentation	Obesity, moon face, high BP, diabetes
Psychological	Depression, apathy, psychosis (rare)	Mood swings, anxiety, psychosis (severe cases)
Calcium Levels	May be elevated (hypercalcaemia)	Usually normal, but can cause hypokalemia
Carbohydrate Impact	Minimal	Insulin resistance, glucose intolerance
Treatment	Hormone replacement	Tumor removal, medications, stop steroid use

 

Read also: https://swaresearch.blogspot.com/2023/10/cortisol-endocrine-system-hypothalamic.html

Some related links:

1. Mayo Clinic - Addison's Disease: https://www.mayoclinic.org/diseases-conditions/addisons-disease/symptoms-causes/syc-20350293

2. Mayo Clinic - Cushing's Syndrome: https://www.mayoclinic.org/diseases-conditions/cushings-syndrome/symptoms-causes/syc-20351310

3. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) - Cushing's Syndrome: https://www.niddk.nih.gov/health-information/endocrine-diseases/cushings-syndrome

4. MedlinePlus - Addison's Disease: https://medlineplus.gov/addisonsdisease.html

5. MedlinePlus - Cushing's Syndrome: https://medlineplus.gov/cushingssyndrome.html

Note: By reading my blog, you acknowledge that I do not provide medical diagnoses or treatments. The information provided is meant to answer frequently asked questions and is gathered from reputable scientific papers.