From the Guidelines
High cortisol levels with no identified source can be related to growth hormone deficiency, as evidenced by the complex interplay between growth hormone and cortisol in the body's hormonal balance. According to a recent guideline update on Cushing's disease, growth hormone deficiency (GHD) can potentially worsen hypercortisolism complications, and its prevalence in adults varies with the timing of diagnosis and treatment 1. The relationship between growth hormone and cortisol is complex, as they have opposing metabolic effects, with growth hormone promoting tissue growth and cortisol being catabolic.
When evaluating patients with high cortisol levels and no identified source, it is essential to consider growth hormone deficiency as a potential contributing factor. Key symptoms of growth hormone deficiency, such as increased abdominal fat, reduced muscle mass, and fatigue, can overlap with those of hypercortisolism. To diagnose growth hormone deficiency, endocrinologists typically perform comprehensive testing, including growth hormone stimulation tests, such as the insulin tolerance or glucagon stimulation test, as mentioned in the guideline update by Fleseriu et al. 1.
Treatment of growth hormone deficiency in patients with high cortisol levels would focus on addressing the underlying hormonal imbalance, typically with daily subcutaneous growth hormone replacement therapy. The dosage is individualized based on age, body weight, and response to therapy, with regular monitoring of IGF-1 levels to adjust dosing appropriately. It is crucial to note that directly targeting cortisol levels may not be the primary approach, as the goal is to restore the body's hormonal balance by addressing the growth hormone deficiency. Regular monitoring and adjustments to treatment are necessary to ensure optimal management of both growth hormone deficiency and cortisol levels, as supported by the latest clinical guidelines 1.
Some key points to consider in the management of patients with high cortisol levels and potential growth hormone deficiency include:
- Comprehensive testing, including growth hormone stimulation tests, to evaluate pituitary function
- Individualized treatment with daily subcutaneous growth hormone replacement therapy
- Regular monitoring of IGF-1 levels to adjust dosing appropriately
- Focus on addressing the underlying growth hormone deficiency rather than directly targeting cortisol levels
- Consideration of the complex interplay between growth hormone and cortisol in the body's hormonal balance, as highlighted in the recent guideline update by Fleseriu et al. 1.
From the FDA Drug Label
The microsomal enzyme 11β-hydroxysteroid dehydrogenase type 1 (11βHSD-1) is required for conversion of cortisone to its active metabolite, cortisol, in hepatic and adipose tissue. GH and somatropin inhibit 11βHSD-1. Consequently, individuals with untreated GH deficiency have relative increases in 11βHSD-1 and serum cortisol Introduction of somatropin treatment may result in inhibition of 11βHSD-1 and reduced serum cortisol concentrations.
No, high cortisol levels with no identified source cannot be directly attributed to growth hormone deficiency as the primary cause. The text suggests that growth hormone deficiency is associated with relative increases in 11βHSD-1 and serum cortisol, but it does not indicate that growth hormone deficiency directly causes high cortisol levels. Instead, it implies that the introduction of somatropin treatment may result in reduced serum cortisol concentrations due to the inhibition of 11βHSD-1 2.
From the Research
High Cortisol Levels and Growth Hormone Deficiency
- High cortisol levels can be caused by various factors, including Cushing's disease, and can have severe adverse effects on the body 3, 4.
- Growth hormone deficiency (GHD) can occur in patients with Cushing's disease, either as a consequence of cortisol excess or due to pituitary surgery or radiation therapy 5, 6.
- GHD can share many clinical features with Cushing's disease, making it difficult to diagnose, and its presence can worsen the systemic complications caused by previous hypercortisolism 5.
- Elevated cortisol levels can be found in many diseases, including those with no known origin, and high cortisol may actually play a major role in inducing these diseases 7.
Relationship Between High Cortisol Levels and Growth Hormone Deficiency
- There is evidence to suggest that high cortisol levels can suppress growth hormone secretion, which may spontaneously recover over time after successful therapy for hypercortisolism 5.
- GH deficiency can be diagnosed using dynamic testing, including insulin, glucagon, or macimorelin stimulation, and serum insulin-like growth factor I (IGF-I) can be helpful in the diagnosis of GHD among patients with multiple additional pituitary hormone deficiencies 6.
- Growth hormone replacement therapy may improve body composition, bone density, exercise capacity, dyslipidemia, and quality of life in patients with GHD, including those with a history of Cushing's disease 5, 6.
Diagnosis and Treatment of High Cortisol Levels and Growth Hormone Deficiency
- Early diagnosis and treatment of hypercortisolism are crucial to prevent adverse effects, and more attention should be paid to early treatment and prevention of adverse effects 3.
- The diagnosis of GHD requires careful evaluation, and GH replacement therapy should be considered in patients with Cushing's disease in remission 6.
- A standardized cortisol circadian rhythm chart may be helpful in unveiling the role of cortisol in diseases and enabling a more accurate comparison with cortisol values obtained under pathological conditions 7.