Hyperfunction of the adrenal glands involves excess production of the adrenal hormones cortisol (resulting in Cushing syndrome) or aldosterone (resulting in hyperaldosteronism).
Adrenal gland hypofunction is associated with primary (Addison disease) or secondary adrenal insufficiency.
WHAT ARE THE CAUSES OF ADRENAL GLAND DISORDERS?
Cushing syndrome results from effects of supraphysiologic glucocorticoid levels originating from either exogenous administration or endogenous overproduction by the adrenal gland (adrenocorticotropic hormone [ACTH] dependent) or by abnormal adrenocortical tissues (ACTH independent).
ACTH-dependent Cushing syndrome (80% of all Cushing syndrome cases) is usually caused by overproduction of ACTH by the pituitary gland, causing adrenal hyperplasia. Pituitary adenomas account for about 85% of these cases (Cushing disease). Ectopic ACTH-secreting tumours and nonneoplastic corticotropin hypersecretion cause the remaining 20% of ACTH-dependent cases.
Ectopic ACTH syndrome refers to excessive ACTH production resulting from an endocrine or nonendocrine tumour, usually of the pancreas, thyroid, or lung (e.g., small-cell lung cancer).
ACTH-independent Cushing syndrome is usually caused by adrenal adenomas and carcinomas.
WHAT ARE THE SIGNS AND SYMPTOMS OF ADRENAL GLAND DISORDERS?
The most common findings in Cushing syndrome are central obesity and facial rounding (90% of patients). Peripheral obesity and fat accumulation occur in 50% of patients. Fat accumulation in the dorsocervical area (buffalo hump) is nonspecific, but increased supraclavicular fat pads are more specific for Cushing syndrome. Patients are often described as having moon facies and a buffalo hump.
Other findings may include myopathy or muscular weakness, abdominal striae, hypertension, glucose intolerance, psychiatric changes, gonadal dysfunction, facial plethora (a reddish complexion), and amenorrhea and hirsutism in women.
Up to 60% of patients develop Cushing-induced osteoporosis; about 40% present with back pain, and 20% progress to spinal compression fractures.
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