Why this girl didn't look sick despite having too much cortisol
Absence of Cushingoid phenotype in a patient with Cushing's disease due to defective cortisone to cortisol conversion.
Not medical advice. For informational purposes only. Always consult a healthcare professional. Terms
A young woman had high cortisol levels from a pituitary tumor but didn't show any of the usual signs like weight gain or bruises. Doctors found her body couldn't turn a harmless form of cortisol (cortisone) into the active kind.
Surprising Findings
A patient with extreme biochemical hypercortisolemia showed zero classical Cushing's symptoms.
Cushing's syndrome is defined by its unmistakable physical signs—this case breaks every textbook rule.
Practical Takeaways
Don't assume high cortisol levels always mean visible symptoms—individual biology matters.
Not medical advice. For informational purposes only. Always consult a healthcare professional. Terms
A young woman had high cortisol levels from a pituitary tumor but didn't show any of the usual signs like weight gain or bruises. Doctors found her body couldn't turn a harmless form of cortisol (cortisone) into the active kind.
Surprising Findings
A patient with extreme biochemical hypercortisolemia showed zero classical Cushing's symptoms.
Cushing's syndrome is defined by its unmistakable physical signs—this case breaks every textbook rule.
Practical Takeaways
Don't assume high cortisol levels always mean visible symptoms—individual biology matters.
Publication
Journal
The Journal of clinical endocrinology and metabolism
Year
2002
Authors
J. Tomlinson, N. Draper, J. Mackie, Alan P. Johnson, G. Holder, P. Wood, P. Stewart
Related Content
Claims (4)
In fat tissue, an enzyme called 11β-HSD1 changes cortisone into cortisol, which increases cortisol levels in that area and leads to greater buildup of visceral fat.
Some people with high levels of cortisol in their blood do not show the typical physical signs of Cushing's disease, such as weight gain or bruising, which may be due to their bodies converting less cortisone into active cortisol in tissues.
In people with Cushing's disease, a specific ratio of steroid metabolites in urine is lower than normal, which suggests that the enzyme responsible for activating cortisone into cortisol is not working fully.
After surgery to treat Cushing's disease, some patients show very low levels of cortisol in the blood, reduced ability to convert cortisone to cortisol, and faster clearance of cortisol from the bloodstream, suggesting a partial deficiency in the enzyme 11beta-HSD1.