Which metabolic change is commonly seen in Cushing's syndrome?

Which metabolic change is commonly seen in Cushing's syndrome?

• A. Hyperglycemia
• B. Hypoglycemia
• C. Hypokalemia
• D. Hypocalcemia

Answer: (A)

Excess cortisol in Cushing's syndrome drives hyperglycemia by increasing liver glucose production and by making tissues less responsive to insulin. Cortisol ramps up gluconeogenesis, upregulating enzymes that generate glucose from non-carbohydrate sources, and it also promotes insulin resistance, so glucose isn’t taken up efficiently by muscle and fat. The combination raises fasting and postprandial blood sugar, and can lead to impaired glucose tolerance or diabetes. Hypoglycemia would be unlikely because cortisol tends to raise, not lower, blood glucose. While very high cortisol can sometimes cause potassium loss via mineralocorticoid effects, hypokalemia isn’t the typical or defining metabolic change of Cushing’s syndrome, and hypocalcemia isn’t a direct feature of cortisol excess.

Excess cortisol in Cushing's syndrome drives hyperglycemia by increasing liver glucose production and by making tissues less responsive to insulin. Cortisol ramps up gluconeogenesis, upregulating enzymes that generate glucose from non-carbohydrate sources, and it also promotes insulin resistance, so glucose isn’t taken up efficiently by muscle and fat. The combination raises fasting and postprandial blood sugar, and can lead to impaired glucose tolerance or diabetes.

Hypoglycemia would be unlikely because cortisol tends to raise, not lower, blood glucose. While very high cortisol can sometimes cause potassium loss via mineralocorticoid effects, hypokalemia isn’t the typical or defining metabolic change of Cushing’s syndrome, and hypocalcemia isn’t a direct feature of cortisol excess.