Sexual Manifestations & Infections
Hypercortisolism will directly inhibit the hypothalamus and pituitary gland, leading to suppression of organs that produce sex hormones thus inhibiting them from producing sex hormones. This hormonal suppression will result in gonadal dysfunction [8] in both men and women, being manifested by a decrease in the associated libido and a decrease in testosterone levels in male patients. 80% of female patients have, in addition to reduced libido, menstrual changes such as amenorrhea (no menses), oligorrhea (little menstrual flow) or menorrhagia (abnormal, prolonged or heavy menstrual flow.
The immunosuppressive and anti-inflammatory actions of glucocorticoid hormones are well known, being widely used in a therapeutic manner in several situations. Thus, hypercortisolism will also cause immunosuppression, since it causes a decrease in the number of cells that helps to fight infections and disease in the body. It inhibits the activity of many helper cells in the body as well as white blood cells that help to fight bacteria and other infectious organisms, Thus, infections become more common among patients with Cushing syndrome, these infectious processes being the main cause of morbidity in these patients, who may present, for example, reactivation of tuberculosis, opportunistic infections [9] and cutaneous or systemic fungal infections.