Journal of Yeungnam Medical Science

Original article

Public Health, Environmental, and Occupational Health
Effects of electronic smoking on daytime plasma cortisol levels and the possible ameliorating role of physical activity: a cross-sectional study: Mahmoud A. Alomari, Omar F. Khabour; J Yeungnam Med Sci. 2025;42:58. Published online September 22, 2025; DOI: https://doi.org/10.12701/jyms.2025.42.58

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Abstract PDF Supplementary Material: Background
Cortisol is a hormone that regulates metabolism, circadian rhythm, homeostasis, immunity, and normal growth. Physical activity has numerous health benefits, and smoking is associated with several chronic conditions. This study aimed to investigate the combined effects of physical activity and smoking on circulating cortisol levels.
Methods
Diurnal plasma cortisol levels were measured among individuals (age, 35±14 years; n=974) who smoked electronic (e)-cigarettes (n=239), cigarettes (n=230), waterpipes (n=268), and those who did not smoke (n=237) according to physical activity level.
Results
Two-way analysis of covariance showed an effect on cortisol levels of moderate physical activity (p<0.02) and smoking status (p<0.001) without an interaction effect (p>0.3). Group comparisons showed increased (p<0.001) cortisol among e-cigarette users (247.1±7.4 ng/mL) compared to cigarette users (177.8±7.2 ng/mL), waterpipe users (179.8±6.2 ng/mL), and nonsmokers (181.2±7.2 ng/mL) with no statistical differences between other groups (p>0.05). In addition, among the nonsmokers and cigarette smokers, cortisol levels were reduced in individuals with higher participation in moderate physical activity compared to levels in individuals with lower participation (p<0.005).
Conclusion
These results indicate that e-cigarette use is associated with plasma cortisol levels. Physical activity appears to temper cortisol levels in both cigarette smokers and nonsmokers. However, physical activity may not be sufficient to temper plasma cortisol levels associated with e-cigarette use.

Case reports

Endocrinology, Diabetes, and Metabolism
Ruptured triple hormone-secreting adrenal cortical carcinoma with hyperaldosteronism, hypercortisolism, and elevated normetanephrine: a case report: Sin Yung Woo, Seongji Park, Kun Young Kwon, Dong-Mee Lim, Keun-Young Park, Jong-Dai Kim; J Yeungnam Med Sci. 2024;41(4):306-311. Published online September 6, 2024; DOI: https://doi.org/10.12701/jyms.2024.00626

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We report a case of a ruptured triple hormone-secreting adrenal mass with hyperaldosteronism, hypercortisolism, and elevated normetanephrine levels, diagnosed as adrenal cortical carcinoma (ACC) by histology. A 53-year-old male patient who initially presented with abdominal pain was referred to our hospital for angiocoagulation of an adrenal mass rupture. Abdominal computed tomography revealed a heterogeneous 19×11×15 cm right adrenal mass with invasion into the right lobe of the liver, inferior vena cava, retrocaval lymph nodes, and aortocaval lymph nodes. Angiocoagulation was performed. Laboratory evaluation revealed excess cortisol via a positive 1-mg overnight dexamethasone suppression test, primary hyperaldosteronism via a positive saline infusion test, and plasma normetanephrine levels three times higher than normal. An adrenal mass biopsy was performed for pathological confirmation to commence palliative chemotherapy because surgical management was not deemed appropriate considering the extent of the tumor. Pathological examination revealed stage T4N1M1 ACC. The patient started the first cycle of adjuvant mitotane therapy along with adjuvant treatment with doxorubicin, cisplatin, and etoposide, and was discharged. Clinical cases of dual cortisol- and aldosterone-secreting ACCs or ACCs presenting as pheochromocytomas have occasionally been reported; however, both are rare. Moreover, to the best of our knowledge, a triple hormone-secreting ACC has not yet been reported. Here, we report a rare case and its management. This case report underscores the necessity of performing comprehensive clinical and biochemical hormone evaluations in patients with adrenal masses because ACC can present with multiple hormone elevations.

Citations

Citations to this article as recorded by

Adrenocortical Carcinoma Presenting With Concurrent Cushing Syndrome and Primary Hyperaldosteronism
Naseem Eisa
AACE Endocrinology and Diabetes.2026;[Epub] CrossRef
Terahertz multiband metamaterial biosensor for ultrasensitive detection of PC-12 adrenal gland carcinoma cells through microenvironmental analysis
Musa N. Hamza, Mohammad Alibakhshikenari, Bal Virdee, Sunil Lavadiya, Iftikhar ud Din, Bruno Sanches, Slawomir Koziel, Syeda Iffat Naqvi, Ali Farmani, Abinash Panda, Hassan Zakeri, Nisar Ahmad Abbasi
Sensors and Actuators A: Physical.2026; 405: 117797. CrossRef
Metanephrine-secreting adrenocortical carcinoma in a dog with clinical and biochemical features suggestive of pheochromocytoma
Daesik Kim, Seol-Gi Park, Joungsun Moon, I-se O, Min Su Kim
Journal of Veterinary Internal Medicine.2026;[Epub] CrossRef
Aldosterone-producing adrenocortical carcinoma: An updated review based on a clinical case
Andreu Simó-Servat, Luis García Pascual, Verónica Perea, Carlos Puig-Jové, Carmen Quirós, María-José Barahona
Endocrinología, Diabetes y Nutrición.2026; : 501849. CrossRef
Non-functioning adrenocortical carcinoma presenting as acute spontaneous retroperitoneal haemorrhage
Christopher Chan, Renee C F Chan, Mawson Wang
Endocrinology, Diabetes & Metabolism Case Reports.2026;[Epub] CrossRef

Endocrinology, Diabetes, and Metabolism
Cushing syndrome in pregnancy, diagnosed after delivery: Han Byul Kim, Mi Kyung Kim, El Kim, Keun Soo Ahn, Hye Soon Kim, Nam Kyung Kim; Yeungnam Univ J Med. 2021;38(1):60-64. Published online May 22, 2020; DOI: https://doi.org/10.12701/yujm.2020.00290

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Abstract PDF

Cushing syndrome (CS) is rare in pregnancy, and few cases have been reported to date. Women with untreated CS rarely become pregnant because of the ovulatory dysfunction induced by hypercortisolism. It is difficult to diagnose CS in pregnancy because of its very low incidence, the overlap between the clinical signs of hypercortisolism and the physiological changes that occur during pregnancy and the changes in hypothalamus-pituitary-adrenal axis activity that occur during pregnancy and limit the value of standard diagnostic testing. However, CS in pregnancy is associated with poor maternal and fetal outcomes; therefore, its early diagnosis and treatment are important. Here, we report two patients with CS that was not diagnosed during pregnancy, in whom maternal and fetal morbidity developed because of hypercortisolism.

Citations

Citations to this article as recorded by

Cushing’s disease with twin pregnancy and diabetes mellitus: a case report and literature review
Hideyasu Asai, Ikuo Yamamori, Shigeru Hagimoto, Kyoichi Okumura, Koki Sakakibara
Endocrine Journal.2024; 71(10): 1003. CrossRef
Endogenous Cushing’s syndrome during pregnancy
Nada Younes, Matthieu St-Jean, Isabelle Bourdeau, André Lacroix
Reviews in Endocrine and Metabolic Disorders.2023; 24(1): 23. CrossRef
Cushing Syndrome in Pregnancy: A Case Presentation and Review of Literature
HamidReza Samimagham, Ava Ziaei, Mohammad Tamaddondar, Mitra Kazemi Jahromi
Journal of Kermanshah University of Medical Sciences.2023;[Epub] CrossRef

Case Report

Endocrinology, Diabetes, and Metabolism
A Case of Adrenocortical Carcinoma Secreting Cortisol and Aldosterone.: Jiyoon Ha, Min Kyung Kim, Yoon Jin Cha, Seung Kyu Kim, Gi Young Yun, Kwangwon Rhee, Joon Seong Park, Eun Suk Cho, Chul Woo Ahn, Jong Suk Park; Yeungnam Univ J Med. 2012;29(2):132-135. Published online December 31, 2012; DOI: https://doi.org/10.12701/yujm.2012.29.2.132

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Abstract PDF

Adrenocortical carcinomas are rare and frequently aggressive tumors that may be functional (hormone-secreting) and may cause Cushing's syndrome or virilization, or non-functional and manifest as an abdominal mass. This paper reports the case of a 77-year-old woman with cortisol- and aldosterone-secreting adrenal carcinoma. The patient complained of general weakness, a moon face, and weight gain. She also had hypokalemia and hypertension. Her endocrinological data showed excessive aldosterone production and non-suppressible cortisol production in a low-dose dexamethasone suppresion test. Her abdominal CT showed a right adrenal mass. She underwent right adrenalectomy, and her histology revealed the presence of adrenocortical carcinoma. After adrenalectomy, her hypokalemia returned to normal and she is being treated with hydrocortisone.

Citations

Citations to this article as recorded by

Adrenocortical Carcinoma Presenting With Concurrent Cushing Syndrome and Primary Hyperaldosteronism
Naseem Eisa
AACE Endocrinology and Diabetes.2026;[Epub] CrossRef

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