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Addison's Disease Message Board

Addison's Disease Board Index

I've noticed a lot of talk about Cushing's and cortisol levels. Since I had Cushing's Syndrome (and now have Addison's) I would be more than happy to answer any questions anyone has.

In case you are new to this and are unsure of how ACTH, cortisol, etc works here is a brief outline of what happens when you have Cushing's:

Your pituitary gland is called your master gland. The pituitary's job is to tell all your hormones how to work, and when to work overtime. So say you're almost in a car accident, the pituitary says, "OH NO!" and tells the adrenals to pump out more cortisol. They do, and send a message back to the pituitary that they've done their job, does the pituitary need anything else? If not, they'll calm down and cortisol will return to normal. Cortisol is highest in the morning, and it's what helps get out of bed. At night, cortisol goes down to almost nothing and that helps you sleep. If you have Cushing's that whole system is screwed up and you become a hopeless insomniac.

In Cushing's the whole talking back and forth gets screwed up. In the pituitary it puts out a hormone called ACTH. The pit actually does not produce cortisol. BUT it is responsible for the adrenals putting out the cortisol. When you have a pituitary tumor for Cushing's the tumor is comprised of ACTH. That tumor's ACTH takes over and the normal ACTH from the pit takes a long nap.

So instead of the pit doing all the work, the tumor does it. And the tumor is always working, 24 hours a day. So those poor work-horse adrenals are always going, spitting out cortisol all the time. Alternatively, if you have an adrenal tumor then it always puts out cortisol and tells the pit with it's ACTH to take a hike. The other adrenal (you have two) says, "heck, that guy gets all the work. I'm sneaking out and not working. Nobody will notice."

Either way you end up with way too much cortisol. The body is meant to have only so much cortisol, with extra available if needed. When you have surgery to either remove the pit tumor or the adrenal tumor then the ones that weren't working are suddenly, and without warning, called to action. And they just aren't ready. So they wake up, but very slowly and need to be helped along with man-made cortisol in the form of, most commonly, prednisone or hydrocortisone. After six months to a year the adrenal or pituitary wakes up and the man-made cortisol can be done with.

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