ABNORMALITIES OF ADRENOCOTICAL

1. Abnormalities of Adrenocortical Secretion
Hyperadrenalism
– Cushing`s Syndrome.
• Hypersecretion by the adrenal cortex causes a
complex Cascade of hormone effect called
Cushing`Syndrome.
• Cushing`s Syndrome is a disorder characterized
by obesity.
• Causes.
• Cushing`s syndrome is due to hypersecretion of
glucocorticoide,particularly cortisol.
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2. • It may be either due to pituitary origin or adrenal
origin.
• If it is due to pituitary origin it is known as
cushing`s disease.
• If it is due to adrenal origin it is called cushing`s
syndrome.
Pituitary Origin.
• Increased secretion of ACTH causes
hyperplasia of adrenal cortex leading to
hypersecretion of glucocorticoid.
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3. • ACTH secretion is increased by,
1.Tumor in pituitary cells particularly in
basophilic cells.
2.Malignant tumor of non endocrine origin
like cancer of lungs.
3.Hypothalamic disorder causing
hypersecretion of corticotropin releasing
hormone.
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4. Adrenal Origin
Cortisol secretion is increased by,
1.Tumor in zona fasciculata of adrenal
cortex.
2. prolonged treatment of chronic
inflammatory diseases like rheumatoid
arthritis with high dose of exogenous
glucocorticoids.
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5. Cushing`s syndrome is classified into
two types.
1.ACTH dependant cushing`s syndrome which is
due to hypersecretion of ACTH.
2.ACTH independent cushing`s syndrome in
which the secretion of ACTH is normal.The
syndrome develops due to abnormal membrane
receptors for some peptides like inter leukin-
1,gonadotropin releasing hormone and gastric
inhibitory poly peptide in the cells of zona
fasciculata.
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6. • The binding of these peptides to the abnormal
receptors increases secretion of glucocorticoids
resulting in cushing`s syndrome.
Signs and Symptoms
1. Disproportionate distribution of body resulting in
some abnormal features,
a) Moon face.
b)Torso (trunk of the body).
c)Buffalo hump.due to fat deposit on the back of
the neck and shoulder.
d) Pot belly.
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7. 2. Purple striae. Reddish purple stripes on
abdomen.
3. Thinning of skin and subcutaneous
tissues due to protein depletion caused
by increased catabolism of proteins.
4. Darkening of skin on neck (aconthosis).
5. 5.Pigmentation of skin.
6. 6.Facial redness (facial plethora).
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8. 7. Facial hair growth (hirsutism).
8. Weakening of muscles.
9. Hyperglycemia.
10. Poor wound healing.
Tests for Cushing`s Syndrome
1.Observation of external features.
2.Determination of blood sugar and cortisol levels.
3.Analysis of urine for 17 hydroxy steroids.
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9. Treatment for Cushing`s Syndrome.
• The treatment depends upon the cause of the
disease.
• Treatment may include cortisol inhibiting drugs,
• Surgical removal of pituitary or adrenal tumor,
• Radiation or chemotherapy.
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10. Addison’s Disease
Hypoadrenalism-
• Addison`s Disease.
• It is the failure of adrenal cortex to secrete all
the corticosteroids.
• It is classified into three types,
1.Primary Addison’s disease.
Due to adrenal cause,
2.Secondary Addison`s disease,
Due to failure of anterior pituitary to secrete ACTH,
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11. 3.Tertiary Addison`s disease,
Due to failure of hypothalamus to secrete CRF.
Causes for primary Addison's disease.
1.Atrophy of adrenal cortex due to autoimmune
diseases.
2.Destruction of the gland b/c of tuberculosis.
3.Congenital failure to secrete cortisol.
4.Destruction of hormone secreting cells in adrenal
cortex by malignant tissues.
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12. 5.Adrenalectomy and failure to take hormone
therapy.
Signs and Symptoms
b/c of deficiency of both cortisol and aldosterone
• Pigmentation of skin and mucous membrane,
due to excess ACTH secretion b/c of cortisol
defieciency. ACTH causes pigmentation by its
melanocyte stimulating action.
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13. • Muscular weakness.
• Dehydration with loss of sodium.
• Hypotension.
• Decreased cardiac output .
• Hypoglycemia.
• Nausea ,vomiting and diarrhea.
• Loss of weight.
• Loss of body hair.
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14. Tests for Addison’s Disease.
• Measurement of blood level of cortisol and
aldosterone.
• The short ACTH stimulation test.
• Plasma ACTH level.
• Chest X-rays may show evidence of
tuberculosis.
Treatment
• Long trem treatment is with replacement
glucocorticoids and mineralcorticoids.
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