The HPA Axis: Alcohol-Induced Pseudo-Cushing’s Syndrome



Figure 1.  Hypothalamic-Pituitary-Adrenal Axis

What is the HPA axis?


The hypothalamus is the control center for most of body’s hormonal systems. 


Follow figure 1 as I explain this.  Cells in hypothalamus produce hormone corticotrophin-releasing factor (CRF) in humans in response to most any type of stress physical or psychological. 


The hypothalamus secretes CRF, which in turn binds to specific receptors on pituitary cells, which produce adrenocorticotropic hormone (ACTH). 

ACTH is then transported to its target the adrenal gland stimulates the production of adrenal hormones.


The adrenal glands that are located on top of the kidneys then increase the secretion of cortisol.


The release of cortisol initiates a series of metabolic effects aimed at alleviating the harmful effects of stress through negative feedback to both the hypothalamus and the anterior pituitary, which decreases the concentration of ATH and cortisol in the blood once the state of stress subsides.


What happens to an alcoholic’s HPA axis?


They may develop something similar to a disorder called Cushing’s syndrome, which is caused by excess of cortisol.  The development of this disease in alcoholics is due to a clinically significant activation of the HPA axis.

This is a face with edema, abnormal accumulation of fluid in interstitial spaces of tissues, which can be found in patient’s with Cushing’s syndrome.

Signs include:

Obesity of torso

Purplish stretch marks

Round red face

High blood pressure

Muscle weakness

Easy bruisability




Variety of psychological disturbances

Women may develop facial hair                               


Drinkers develop alcohol-induced pseudo-Cushing's syndrome, indistinguishable from true Cushing’s but usually clinically less severe.

If a person has pseudo-Cushing’s syndrome that is related to alcohol and they stop drinking the symptoms and signs will disappear within two to four months.

The prevalence of this disease is unknown.





Back to Overview of Endocrine System

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