Long-term stress, certain ectopic tumors, or even tumors of the HPA axis can cause excess cortisol production. Increased levels of cortisol can lead to further problems such as immunosuppression, bone and muscle problems, and potentially diabetes. Primary hyperadrenalism (hypercortisolism) is also known as Cushing's syndrome. Cushing's syndrome is the result of excess cortisol being produced by the adrenal gland often caused by an infection, cancer, trauma, or an idiopathic cause. Signs and symptoms are very noticeable and include upper body obesity, rounded face, increased neck and shoulder fat (buffalo hump), thin arms and legs, fragile skin, increased stretch marks on various body sites, muscle and bone weakness, hypertension, hyperglycemia, irritability, anxiety, excess facial hair in women, irregular menstrual cycles, and reduced fertility in men.
Similar to hypoadrenal conditions, hyperadrenalism can be primary, secondary, or tertiary depending on the source of the excess cortisol production. Cushing's syndrome encompasses all causes of excess glucocorticoid (primary, secondary, or tertiary), whereas Cushing's disease is reserved only for pituitary-dependent Cushing syndrome (secondary hyperadrenalism).
