Alcoholism & Addiction

Alcoholism and Pseudo-Cushing Syndrome

Pseudo-Cushing syndrome is a term doctors use to describe a medical condition that produces symptoms nearly identical to the symptoms of Cushing syndrome, a disorder caused by the presence of excessive amounts of a naturally occurring hormone called cortisol. People with both of these syndromes develop harmful, hormone-related changes in several different body systems, including their bones, muscles and skin. The underlying reason for the onset of pseudo-Cushing syndrome is the chronic, heavy alcohol intake associated with alcoholism. Alcoholism has this effect because it triggers unwanted activation of a hormone network in the body called the HPA axis.

HPA Axis Basics

The HPA axis gets its name because it includes three structures in the body called the hypothalamus, the pituitary gland, and the adrenal glands. The hypothalamus and pituitary gland are located in different parts of the brain, while a single adrenal gland sits on top of each of your kidneys. All three of these structures belong to the endocrine system, a network made up almost entirely of hormone-producing organs called glands; the hormones released by these glands make critical contributions to everyday human health by sending out a vast array of chemical messages that regulate or alter the function of various types of cells located throughout the body.

The hypothalamus acts as the command center for most of the glandular activity in the endocrine system. It plays its role in the HPA axis by releasing a specific hormone, called corticotrophin-releasing hormone or CRH, in response to mental or physical stress. In turn, CRH makes its way to cells in the pituitary gland, where its presence causes the release of a pituitary hormone called adrenocorticotropic hormone (ACTH). This hormone moves through the bloodstream from the pituitary gland to the adrenal glands, where it encourages the release of an adrenal gland hormone called cortisol. Cortisol is the body’s primary stress hormone, and its presence in the bloodstream helps produce a range of system alterations that support the inborn “fight-or-flight” response.

Cushing Syndrome

As indicated previously, true Cushing syndrome occurs when the adrenal glands produce excessive amounts of cortisol. Potential underlying causes of this excessive production include a pituitary gland disorder called Cushing’s disease, an adrenal gland tumor, a tumor in any other body location that triggers a cortisol increase, and a tumor in any body location that triggers an increase an ACTH increase. Symptoms common to most people with the syndrome (as well as people with pseudo-Cushing syndrome) include obesity that only appears in the torso, an unusually full or round face, acne, unusually thin skin that bruises easily, various skin infections, abnormal accumulations of fat between the shoulder blades, unexplained muscle weakness, back pain, unusually sore or tender bones, bone thinning that leads to easy spine or rib fracturing, impotence and/or loss of sexual interest in men, and menstrual cycle disruptions and male-pattern hair growth in women.

Effects of Alcoholism

Under normal circumstances, the HPA axis is more or less self-regulating; when cortisol levels reach a certain point, they create a hormonal feedback loop that leads to reduced production of CRH inside the hypothalamus, which in turn leads to lowered production of ACTH and cortisol. The level of alcohol consumption associated with alcoholism disrupts this natural feedback loop by triggering CRH production in the hypothalamus and reinitiating activity in the HPA axis, according to an extensive study review conducted in 2010 by the National Institute on Alcohol Abuse and Alcoholism. In turn, reactivation of the axis results in excessive production of cortisol and the onset of pseudo-Cushing syndrome. When alcoholics stop drinking, they typically develop worse symptoms of the syndrome during withdrawal than they experience during active alcohol use.


Some alcoholics don’t develop pseudo-Cushing syndrome, even when they consume alcohol in patterns identical to those found in alcoholics who do develop the syndrome, Medscape Reference reports. No one knows why this is true, or can predict in advance whom the syndrome will affect. As stated previously, the symptoms of Cushing syndrome and pseudo-Cushing syndrome are identical in nature; however, people with pseudo-Cushing syndrome typically have milder forms of these symptoms than people with true Cushing syndrome. The symptoms of pseudo-Cushing syndrome diminish in intensity following the initial period of alcohol withdrawal, and usually disappear altogether over the course of several months if an affected individual successfully maintains his or her sobriety during recovery.

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