Question:  How is it possible for someone to have extremely high cortisol levels and not be obese or get stretch marks?

Answer 1:  Cortisol needs to be high for a long time to cause physical signs of Cushing’s syndrome.  Also, patients with similar cortisol values, for a similar length of time, often look different.  We assume that this may reflect specific aspects of their type of Cushing’s syndrome, but it is very likely that differences in our genes (the blueprint in our cells that codes for our physical appearance) make some people more likely to get certain features.  (Dr. Lynnette Nieman, NIH)

Answer 2:  Elevated cortisol levels are common in many clinical situations that have nothing to do with Cushing syndrome and may or may not cause any signs or symptoms of excessive cortisol production: for example, birth control pills and pregnancy cause elevations of cortisol due to increases in the protein that binds cortisol in the blood. Elevations of urine cortisol also may occur in these women. Patients with eating disorders who may be very thin often have elevated cortisol levels. An increase in cortisol secretion is a well known adaptive response to starvation. Reddish or what we call violaceous stretch marks are a reflection of rapid weight gain in young people with or without Cushing syndrome and are unusual in patients over 40 years of age with Cushing’s. On the other hand, patients with alcohol abuse may have very high cortisol levels which may cause some of the well known clinical manifestations of Cushing syndrome. Rarely, there are individuals who have resistance to cortisol and have elevated cortisol levels but no evidence of Cushing syndrome. (Dr James Findling, Medical College of Wisconsin)

(Winter-Spring 2019)