Table 5.

Conditions associated with physiologic hypercortisolism in the absence of CS, divided into those that may be associated with physical features of hypercortisolism and those in which hypercortisolism is unlikely to be suspected based on physical features

Physical features of CS may be present

Acute psychological stressors, depression, psychosis, obsessive-complusive disorder

Alcohol dependence/withdrawal

Poorly controlled diabetes mellitus

Severe obesity

Obstructive sleep apnea

Glucocorticoid resistance syndromes

End-stage renal disease

Older subjects

Physical features of hypercortisolism less likely

Pregnancy

Malnutrition/anorexia nervosa

Intense chronic exercise (eg marathon competitors)

Physical stress (hospitalization, surgery, pain)

Hypotension/septic shock