adrenocortical hyperfunction n.
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Adrenocortical hyperfunction. There are 3 basic types of corticosteroids elaborated by the adrenal cortex “ glucocorticoids, mineralocorticoids, and sex hormone ” and 3 distinctive hyperadrenal clinical sydromes: Cushing syndrome “ excess cortisol ” Hyperaldosteronism

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Adrenocortical hyperfunction


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adrenocortical hyperfunction
Adrenocortical hyperfunction
  • There are 3 basic types of corticosteroids elaborated by the adrenal cortex “glucocorticoids, mineralocorticoids, and sex hormone”and 3 distinctive hyperadrenal clinical sydromes:
    • Cushing syndrome “excess cortisol”
    • Hyperaldosteronism
    • Adrenogenital syndromes “excess androgen”
cushing syndrome hypercorticolism
Cushing Syndrome “hypercorticolism”
  • Caused by an elevation in glucocorticoid level
  • There are multiple etiologies
    • The most common cause is the administration of exogenous glucocorticoids
    • Primary hypothalamic-pituitary disease associated with hypersecretion of ACTH “Cushings disease”
    • Hypersecretion of cortisol by an adrenal adenoma, carcinoma or nodular hyperplasia
    • The secretion of ectopic ACTH by a nonendocrine neoplasm
cushing disease
Cushing Disease
  • Is the pituitary hypersecretion of ACTH
  • Common in young adult life with a female predominance
  • Associated with and ACTH producing pituitary adenoma or coticotroph hyperplasia
  • It accounts ~ ½ of the cases of endogenous hypercorticolism
  • The adrenals are bilaterally hyperplastic and there is an elevated serum ACTH
adrenal neoplasms
Adrenal neoplasms
  • Adrenal neoplasm “ adrenal adenoma, carcinoma and primary corticol hyperplasia” account for 20-25% of cases of endogenous Cushing syndrome
  • These neoplastic lesions are independent of ACTH
  • Hypercorticolism is usually more marked with carcinomas than with adenomas or hyperplasia
ectopic acth secretion
Ectopic ACTH secretion
  • Ectopic ACTH secretion by non-pituitary tumors account 15- 30& of cases of endogenous Cushing syndrome.
  • Most commonly associated with small cell carcinoma of the lung, carcinoid tumors of the bronchus or pancreas, medullary carcinoma of the thyroid and islet cell tumor of the pancreas.
morphology of cushing syndrome
Morphology of Cushing Syndrome
  • In Cushing Disease, the pituitary shows a hyaline change within basophils caused by elevated glucocorticoid levels
  • In the adrenals, 75 % of the cases with Cushing Syndrome present with diffuse adrenal hyperplasia features or nodular adrenal hyperplasia.
clinical features of cushing syndrome
Clinical features of Cushing Syndrome
  • Central obesity “85-90%”
  • Moon face “85%”
  • Weakness and fatigability “85%”
  • Hirsutism “75%”
  • Plethora “ 75%”
  • Hypertension “75%”
  • Glucose intolerance/diabetes “75%”
  • Osteoporosis “75%”
  • Neuropsychiatric abnormalities “75%”
  • Menstrual abnormalities “70%”
  • Cutaneous striae “50%”
investigations of cushing syndrome
Investigations of Cushing Syndrome
  • Determining the cause of Cushing syndrome depends on measuring the level of serum ACTH and determination of urinary steroid excretion after administration of dexamethasone to suppress ACTH levels
    • Results may need to be coupled with imaging techniques to identify the definite cause of Cushing Syndrome