Yu Run
Division of Endocrinology, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California.
AACE Clin Case Rep. 2024 Jul 14;10(5):206-209. doi: 10.1016/j.aace.2024.07.005. eCollection 2024 Sep-Oct.
BACKGROUND/OBJECTIVE: Extreme hypercortisolemia in an otherwise healthy patient can be due to familial dysalbuminemia, generalized glucocorticoid resistance, and estrogen-containing medications. I report a woman who appeared to have an exaggerated increase in the serum cortisol level following oral contraceptive treatment.
A 50-year-old woman presented with extreme morning hypercortisolemia-cortisol levels of 61 and 55 mcg/dL (4 and 3 months before presentation, respectively; normal range, 8-25 mcg/dL)-found during workup of mildly increased white cell counts. The morning cortisol level had been 10 mcg/dL after administration of 1-mg dexamethasone. The 24-hour urine free cortisol level had been normal and only slightly increased after correction by creatinine. The patient was anxious about the extremely high cortisol levels but otherwise felt well. She took norgestimate-ethinyl estradiol contraceptive (0.18/0.215/0.25 mg - 35 mcg). Physical examination showed a well-appearing, lean female. The thyroid-stimulating hormone, total thyroxine, free thyroxine, total triiodothyronine, free triiodothyronine, androstenedione, dehydroepiandrosterone sulfate, aldosterone, and renin levels were normal. Morning total cortisol and cortisol-binding globulin (CBG) were tested before and after she held the oral contraceptive for 2 months. The total cortisol and CBG levels decreased from 50 to 26 mcg/dL and from 6.4 to 3.8 mg/dL (normal range, 1.7-3.1 mg/dL), respectively.
Increases in the serum cortisol-binding proteins are a well-recognized cause for increases in the serum cortisol levels.
This case suggests that modern oral contraceptives with low to moderate estrogen activity can cause extreme increases in the serum cortisol levels due to marked increases in the CBG levels.
背景/目的：在其他方面健康的患者中，极端高皮质醇血症可能归因于家族性白蛋白异常血症、全身性糖皮质激素抵抗以及含雌激素的药物。我报告了一名女性，她在接受口服避孕药治疗后血清皮质醇水平出现了明显升高。
一名50岁女性因白细胞计数轻度升高进行检查时，发现早晨皮质醇水平极高——分别在就诊前4个月和3个月时，皮质醇水平为61和55 mcg/dL（正常范围为8 - 25 mcg/dL）。服用1毫克地塞米松后，早晨皮质醇水平为10 mcg/dL。24小时尿游离皮质醇水平正常，经肌酐校正后仅略有升高。患者对极高的皮质醇水平感到焦虑，但其他方面感觉良好。她服用诺孕酯 - 炔雌醇避孕药（0.18/0.215/0.25毫克 - 35微克）。体格检查显示该女性外表健康、体型消瘦。促甲状腺激素、总甲状腺素、游离甲状腺素、总三碘甲状腺原氨酸、游离三碘甲状腺原氨酸、雄烯二酮、硫酸脱氢表雄酮、醛固酮和肾素水平均正常。在停用口服避孕药2个月前后，检测了早晨总皮质醇和皮质醇结合球蛋白（CBG）。总皮质醇和CBG水平分别从50降至26 mcg/dL，从6.4降至3.8 mg/dL（正常范围为1.7 - 3.1 mg/dL）。
血清皮质醇结合蛋白增加是血清皮质醇水平升高的一个公认原因。
该病例表明，具有低至中度雌激素活性的现代口服避孕药可因CBG水平显著升高而导致血清皮质醇水平极度升高。
