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Rephrase and shorten “With ACTH-dependent hypercortisolism, the excess ACTH stimulates excess production of cortisol and there is loss of feedback control of ACTH secretion. Whatever the cause, two observations consistently apply to individuals with Cushing syndrome: (1) they do not have diurnal or circadian secretion patterns of ACTH and cortisol, and (2) they do not increase ACTH and cortisol secretion in response to a stressor.178 In individuals with ACTH-dependent hypercortisolism, secretion of both cortisol and adrenal androgens is increased, and corticotropin-releasing hormone (CRH) secretion is inhibited. ACTH-independent secreting tumors of the adrenal cortex, however, generally secrete only cortisol. Elevated cortisol levels suppress CRH and ACTH secretion from the hypothalamus and anterior pituitary, respectively, which leads to low levels of ACTH. Low levels of ACTH cause atrophy of the remaining normal portions of the adrenal cortex, which over time will alter the cortisol-secreting activity of normal cells. When the secretion of cortisol by the tumor exceeds normal cortisol levels, symptoms of hypercortisolism develop

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