Disorders of the adrenal cortex can lead to various health issues. Conditions such as Addison's disease result from adrenal insufficiency, causing fatigue, weight loss, and low blood pressure. On the other hand, Cushing's syndrome, caused by excess cortisol, can lead to weight gain, high blood pressure, and muscle weakness. Treatment options depend on the specific disorder and may involve hormone replacement or surgery. Regular medical monitoring is crucial for managing these conditions effectively.
4. Adrenal cortex
❑ Adrenal cortex is the outer region
❑ The largest part of adrenal gland.
❑ It is divided into three separate zones.
▪ Zona glomerulusa
▪ Zona fasciculata
▪ Zona reticularis
Disorders of Adrenal cortex
Hypercortisolism
Adrenalin sufficiency
Hypoaldosteronism
Hyperaldosteronism (Hughes,etals.,2019) Fig.1.1 Adrenal Glands Anatomy
Fig.1.https://step1.medbullets.com/endocrine/109001/adrenal-cortex-and-medulla
5. 1. Hypercortisolism
❑ Also known as cushing syndrome .
❑ It is due to :
▪ Excess or insufficiency of adrenal hormones produce alteration of HPA
axis.
▪ Production of cortisols.
Causes :
▪ Latrogenic (steroid in medications)
▪ ACTH dependent
▪ 80% of excess cortisol caused by tumor because tumor produce excess
adrenocorticotrophic hormone. (Hughes,etals.,2019)
6. Stretch marks
on skin and
skin thining
Excessive
body hair
Depression
High blood
pressure
Oseoporosis
Diabetes
Severe
fatigue
Upper body
obesity
Fig1.2 Cushing Syndromes symptoms
https://www.news-medical.net/health/Cushings-Syndrome-Signs-and-
Symptoms.aspx
7. ❖ Diagonosis
❖ Blood and urine test
❖ Cortisol levels
❖ ACTH levels
❖ Dexamethasone suppression test
❖ Imaging studies
❖ Late night salivary cortisol tests
❖ Treatment
❖ Medications adjustments
❖ Surgery
❖ Radiation therapy
❖ Lifestyle changes
❖ Adrenal blocking drugs (Hughes,etals.,2019)
Fig1.3 Cushing Syndrome
https://www.osmosis.org/answers/Cushing-syndrome
8. 2. Adrenal Insufficiency
Also called Addison disease.it occurs when adrenal gland not
produce enough cortisol.
It is most common between the ages of 30 and 50.
Causes:
Autoimmune diseases
Fungal infections
Pituitary gland tumor
Lack of ACTH leads to secondary adrenal insufficiency
Fig1.4 HPAAxis
https://www.niddk.nih.gov/health information/endocrine-
diseases/adrenal-insufficiency-addisons-disease/definition-
facts
9. Types Of Adrenal Insufficiency
Primary adrenal
insufficiency
Adrenal glands are affected
Cortisol level is low
ACTH level is high
Sodium low while potassium high.
Cortisol and aldosterone replacement
are required.
Secondary adrenal
insufficiency
Pituitary gland are affected
Cortisol level is low
ACTH level is also low
Sodium and potassium are relatively
normal.
Cortisol replacement are required
13. 3. Hyperaldosteroinism
Also known as Conn Syndrome.
It is due to the release of too much aldosterone into the blood.(Husebye,etals.,2021)
Primary hyperaldosteronism Secondary hyperaldosteronism
It is aldosterone secreting tumor.
Congenital adrenal hyperplasia
It is renovascular disease.
Renin secreting tumor,
The renin level is normal or low. The renin level is high
The aldosterone level is high. The aldosterone level also high.
14. Low levels of
potassium in
the blood
Numbness
Feeling tired
al the time
Heart disease
High BP
Kidney
Diseases
Memory loss
Depression
Stroke
Fig1.8 Conn Syndrome & symptoms
https://www.adrenal.com/blog/conn-s-syndrome-a-silent-
killer.
16. 4. Hypoaldosteronism
Decreased synthesis or release of aldosterone
from zona glomerulusa.
In resistance condition aldosterone levels are
elevated called Pseudohypoaldosteronism.
Causes
Destruction of adrenal gland use to infection
Autoimmune problems
Genetic disorders. (Edwards,etals.,2015)
17. Weight loss Low BP Salt craving
palpitation dizziness
Gastrointestinal
problems
Fig1.9 Hypoaldosteronism
https://quizlet.com/539992404/renal-integrative-examples-flash-cards/
18. Diagnostic test
Simple blood tests
Plasma aldosterone concentration
Plasma renin activity
Treatment
Low potassium diet with increases sodium intake.
Loop or thiazide to enhance potassium excretion.(Edwards,etals.,2015)
19. Refrences
▪ Hughes, C. R., Man, E., &Achermann, J. C. (2019).The adrenal
cortex and its disorders. Brook's Clinical Pediatric Endocrinology,
335-407.
▪ Miller,W.L.,Fluck,C.E.,Breault,D.T.,&Feldman,B.J.(2021).The
adrenal cortex and its disorders. In Sperling Pediatric Endocrinology
(pp.425-490). Elsevier.
▪ Husebye,E.S., Pearce,S.H.,Krone,N.P.,& Kampe,O.(2021).Adrenal
insufficiency.The Lancet,397(10274),613-629.
▪ Edwards,L.D.,Heyman,A.H.,&Swidan,S.(2011).Hypercortisolism:
An evidence – based review.Integrative Medicine,10(4),30.