Question: I have Cushing’s and have this incredible desire to eat all the time. Is there a medical explanation as to why we want to eat so much? Will this resolve once my Cushing’s is cured?

Answer: Excessive cortisol levels do stimulate appetite and account for the rapid weight gain that occurs with Cushing’s syndrome. The best way to deal with it is to bring the cortisol levels back to normal. This should occur if Cushing’s syndrome is cured. There are several possible mechanisms by which patients with Cushing’s have increased appetite. Insulin resistance associated with high insulin levels may be a cause since insulin plays a regulatory role on hunger and satiety. Also, some of the adipokines (leptin, resistin, adiponectin), fat cell chemicals that affect energy regulation are affected by cortisol and may disrupt the physiological control of energy metabolism and cause increased hunger.

References

Krsek M, et al. Adipokine levels in Cushing’s syndrome; elevated resistin levels in female patients with Cushing’s syndrome. Clinical Endocrinology 60:350; 2004

Ghizzoni et al. Leptin, cortisol and GH secretion interactions in short normal prepubertal children, J Clin Endocrinol Metab 86:3729; 2001

Gavrila et al. Diurnal and ultradian dynamics of serum adiponectin in healthy men: comparison with leptin, circulating soluble leptin receptor, and cortisol patterns. J Clin Endocrinol Metab 88:2838; 2003

By Dr. David E. Schteingart MD (Winter, 2005)