Disorders of the Adrenal

Cortex

Advanced Pathophysiology
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The Adrenal
Cortex

• Under the control of the hypothalamus-pituitary axis

via negative feedback
• Stimulated by adrenocorticotropic hormone (ACTH),
which is secreted by the anterior pituitary gland
+ Pituitary gland is stimulated by corticotropin
releasing hormone (CRH), which is secreted by
the hypothalamus
• Adrenal cortex secretes glucocorticoids (cortisol) and
mineralocorticoids (aldosterone)

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Adrenal Cortex Hormones

GLUCOCORTICOIDS MINERALOCORTICOIDS
• Cortisol (think glucose regulation and anti- • Aldosterone (think salt regulation!)
inflammation!)
+ Maintain normal intravascular volume by
+ “Stress hormone”
retention of water and Na and excretion of K
+ Regulates immune function: promotes overall state of
anti-inflammation (med: hydrocortisone)
+ Regulates metabolism by promoting: GONADOCORTICOIDS
• Breakdown of fats into energy
• Production of glucose and breakdown of glycogen (liver)
• Androgens & estrogens (WEAK sex hormones)
• Small amount of androgens secreted
• Breakdown of proteins to aid in process of gluconeogenesis
• Even smaller amount of estrogens secreted
(muscles)
• Sex hormones - secondary sex characteristics
+ Increases insulin resistance in cells  ↑ blood glucose (puberty)
+ Promotes mental alertness and performance
+ Aids in memory retrieval (emotional)
+ Inhibits bone formation and wound healing

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Cushing Syndrome cause by adenoma = Cushing

Disease = most common cause of
Cushing Syndrome Cushing Syndrome

• Oversecretion of glucocorticoids + Hypertension

(cortisol) • Binds to mineralocorticoid receptors,
enhancing their effects
+ ↑ BG, insulin resistance, ↑ fat stores
around abdomen
+ Moon face/buffalo hump
+ Muscle wasting, bone fractures (d/t over
breakdown of protein in muscle and bone)
+ Dampens inflammatory response

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Cushing’s Syndrome
Symptoms

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Cushing Syndrome

• In some cases, we may also see • Inhibition of gonadotropin releasing

oversecretion of mineralocorticoids and
androgens
• Mineralocorticoids: fluid/Na retention
(HTN)
hormone (GnRH) - which acts on the
ovaries and testes
+ Females: adrenal release leads to higher than
normal levels of testosterone
• Menstrual irregularities, infertility, hair growth
+ Males: adrenal release leads to lower than
normal levels of testosterone
• Low testosterone levels, decreased libido

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Cushing Syndrome
• Causes:
+ Excess administration of exogenous
glucocorticoids
+ Cushing Disease: hypersecretion of ACTH
from the pituitary gland
• Adenoma
+ Ectopic ACTH syndrome
• Paraneoplastic syndrome
• Small cell carcinoma of the lung
• Pregnancy Considerations:
+ Maternal Cushing Syndrome can cause:
• Low birth weight
• Excess androgens: masculization of female
fetus, ambiguous genitalia at birth
• Treatment:
+ Tumor-related: surgery
+ Reduction of steroids if possible
SAMPLE FOOTER TEXT 8
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Adrenal Incidentaloma

• Adrenal tumor found by coincidence

without clinical symptoms or suspicion
• Subclinical Cushing Syndrome

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Adrenocorticol Insufficiency
• Causes:
+ Addison’s Disease (80%): autoimmune • Symptoms:
destruction of adrenal cortex
+ Weakness
+ Lethargy/fatigue
+ Anorexia
+ Nausea
+ Joint pain
+ Abdominal pain
+ Hypoglycemia (occasional)
+ Hyperpigmentation of skin (primary)
• ACTH stimulates melanocytes in skin to
produce melanin

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Questions?
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