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Women may have acne, hirsutism, and oligomenorrhea or amenorrhea resulting from the increased adrenal androgen secretion. Emotional changes range from irritability or emotional lability to severe depression or confusion; even psychosis can occur as well. Cushing and glucocorticoid use are also associated with hypokalemia and leukocytosis. Other manifestations are delayed wound healing, renal calculi from increased calcium levels, and glaucoma. There is increased susceptibility to infections because neutrophils exhibit diminished function because of high glucocorticoid levels. The diagnostic tests used to establish the syndrome of cortisol excess are the 1-mg overnight dexamethasone suppression test and the 24-hour urine- free cortisol.

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