What makes cortisol and cortisone get metabolized more or less quickly if someone has low free cortisol and cortisone but high metabolites of both forms, for instance? Why might that be? If someone has high cortisol and low metabolites, what might be preventing it from being metabolized?

Dr. Amy Nett: Okay, so last week—I think we talked about this last week a little bit. So, I think what you’re asking about here is cortisol metabolism or clearance. Again, this is cortisol or cortisone metabolism, but cortisol is metabolized by the 5-α and 5-β reductase. It’s metabolized for excretion into the α-THF and β-THF forms, and cortisone gets metabolized by 5-β into THE. Things that are going to increase clearance are generally going to be obesity, high insulin, and hyperthyroidism. Sluggish metabolism or decreased clearance is most often going to be seen with hypothyroidism, anorexia, or poor liver function. Those are the major things I think of. Again, patients don’t always present exactly as we would expect them to, but those are the things that you can think about.