Question: I have been under constant, extreme stress for the past year and am now being tested for Cushing's. Can chronic stress cause elevated cortisol levels in the 24 hr urine test, the low dose dexamethazone test and the night-time salivary cortisol test? Also, can extreme stress cause Cushing's symptoms?

Answer: Stress may certainly increase cortisol secretion. Many types of stress have actually been studied and, in most cases, the increase in cortisol is within a physiologic range. However, chronic stress leading to significant depression may result in abnormal laboratory studies including urine free cortisol, abnormal dexamethasone suppression, and probably elevated late-night salivary cortisols. There is also data that supports the concept that stress-related increases in cortisol may be associated with some of the known physiological abnormalities seen in Cushing's syndrome such as hypertension, insulin resistance with impaired gluose tolerance, and dyslipidemia.