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.

1. University of Chakwal, Pakistan

2. DISORDERS OF ADRENAL CORTEX
Presented by: Kanza Bakht
Roll no.: 20M-UOC/ZOL-08
BS: Zoology
Session : 2020-2024
Semester : 7th(Morning )
Course title : Endocrinology
Presented to: Dr Syeda Nadia Ahmad

3. Content
• Adrenal gland
• Introduction
• Disorders of Adrenal cortex
• Hypercortisolism
• Adrenalin sufficiency
• Hypoaldosteronism
• Hyperaldosteronism
• Causes
• Symptoms
• Treatment
• References

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

10. Fig1.5 Primary Adrenal Insufficiency & Secondary Adrenal Insufficiencny
https://www.grepmed.com/images/12449/pathophysiology-insufficiency-secondary-endocrinology-primary

11. Fatigue Weakness
Low blood
pressures Dark skin
Weight loss
Severe belly
pain
Fig1.6: Addison's Disease & symptoms
https://blog.studentrdh.com/what-disease-is-
related-to-adrenal-insufficiency/

12.  Diagnosis:
 Blood and urine test.
 Imaging test(Xrays,ultrasound,MRL)
 Treatment:
 Hormone replacement therapies (hydrocortisone, prednisone)
 Glucocorticoid and mineralocorticoid pills
 B vitamins
 B5 (pantothenic acid) (Miller,etals.,2020)

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.

15.  Tests
 Abdominal CTscan
 ECG
 Blood aldosterone and
potassium level
 Kidney ultrasound
Treatment
 Spironolactone (Aldactone)
 Eplerenone(inspra)
 Laparoscopic adrenalectomy
(Husebye,etals.,2021)

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.