Primary hypercortisolism

Hyperfunction of the adrenal glands occurs in Cushing s syndrome, a disorder caused by excessive secretion of cortisol by the adrenal gland (hypercortisolism). Other causes of adrenal gland hyperfunction include primary and secondary aldosteronism (not discussed in this chapter refer to textbook Chap. 79 for more information on these disorders). 

Metyrapone is used in the differential diagnosis of both adrenocortical insufficiency and Cushing s syndrome (hypercortisolism). The drug tests the functional competence of the hypothalamic-pituitary axis when the adrenals are able to respond to corticotrophin that is, when primary adrenal insufficiency has been ruled out. 

Hypercortisolism in depression is the peripheral indicator of a general disturbance of the entire stress regulation. A primary reason for the enhanced cortisol release is obviously a central hypersecretion of CRH at the hypothalymic site [29, 31, 32]. The consequence of CRH hypersecretion is not only an increased cortisol level but also a down -regulation of glucocorticoid and mineralocorticoid receptors at the level of the pituitary and the hippocampus [33], i.e. a disturbance of the feedback system. 

Endocrine metabolic Body fluid retention, decreased body growth, hypernatremia, osteoporosis, hypercortisolism, hyperglycemia, primary adrenocortical insufficiency... 

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