Adrenal Glands
Dr.Methaq A.M.HusseinMRCP(UK), Endocrine ,D.M (LONDON )F.I.B.M.S,ASSIST.PROFESSOR
The body has two adrenal glands, one near the top of each kidney. The inner part (medulla) of the adrenal glands secretes hormones, such as adrenaline (epinephrine), that help control blood pressure, heart rate, sweating, and other activities also regulated by the sympathetic nervous system. The outer part (cortex) secretes different hormones, including corticosteroids (cortisone-like hormones, such as cortisol) and mineralocorticoids (particularly aldosterone, which controls blood pressure and the levels of salt [sodium chloride] and potassium in the body). The adrenal glands also play a role in stimulating the production of androgens (testosterone and similar hormone
The adrenal glands are controlled in part by the brain. The hypothalamus, produces corticotropin-releasing hormone and vasopressin (also known as antidiuretic hormone). These two hormones trigger the pituitary gland to secretecorticotropin (also known as adrenocorticotropic hormone or ACTH), which stimulates the adrenal glands to produce corticosteroids. The renin-angiotensin-aldosterone system, regulated mostly by the kidneys, causes the adrenal glands to produce more or less aldosterone.
CUSHING’S SYNDROME
What are Cushing’s syndrome and Cushing’s disease?Cushing’s syndrome is a rare condition that occurs when there
is excess cortisol in the body.. It allows us
to respond to stressful situations such as illness or injury, and
has effects on almost all body tissues. It is produced in varying
amounts over the course of the day, most in the early morning,
with very little at night.
Cushing’s syndrome refers to the condition caused by excess
cortisol in the body, regardless of the cause. When Cushing’s
syndrome is caused by a pituitary tumor, it is called Cushing’s
disease.
Cushing’s syndrome is more often found in women than in
men and often occurs between the ages of 20 and 4
What causes Cushing’s syndrome and Cushing’s disease?
Cushing’s syndrome can be caused by cortisol-like medications (calledglucocorticoids) or by a tumor. Sometimes, there is a tumor of the adrenal
gland(s) that makes too much cortisol. Cushing’s syndrome may also be caused
by a tumor in the pituitary gland). Some pituitary
tumors produce a hormone called adrenocorticotropic hormone (ACTH), which
stimulates the adrenal glands and causes them to make too much cortisol. This is
termed Cushing’s disease. ACTH-producing tumors can also originate elsewhere
in the body and these are referred to as ectopic tumors
What are the symptoms of Cushing’s syndrome
COMMON FEATURES LESS COMMON FEATURESWeight gain Insomnia
Hypertension Recurrent infection
Poor short-term memory Thin skin and stretch marks
Irritability Easy bruising
Excess hair growth (women) Depression
Red, ruddy face Weak bones
Extra fat around neck Acne
Round face Balding (women)
Fatigue Hip and shoulder weakness
Poorconcentration Swelling of feet/legs
Menstrual irregularity Diabetes
How is Cushing’s syndrome diagnosed?
Because not all people with Cushing’s syndrome have all signs and symptoms,doctors use laboratory tests to help diagnose Cushing’s
syndrome and, if that diagnosis is made, go on to determine whether it is
caused by Cushing’s disease (i.e., from a pituitary tumor).
The most commonly used tests measure the amount of cortisol in the saliva or
urine. It is also possible to check whether there is over-production of cortisol by
giving a medication called dexamethasone that mimics cortisol. This is called a
dexamethasone suppression test. If the body is regulating cortisol correctly, the
cortisol levels will decrease, but this will not happen in someone with Cushing’s
syndrome.
Pseudo-Cushing’s states
Depression.pregnancy,obesity,alcoholism,strenios excersize,uncontrolled diabetes and sleep apneaThese conditions that mimic Cushing’s
syndrome are called ‘pseudo-Cushing’s states’ a
Because of the overlap in symptoms and laboratory test results
between Cushing’s syndrome and pseudo-Cushing’s states, doctors may have to
do a number of tests and may treat pseudo-Cushing’s states –
What tests are needed specifically to diagnose Cushing’s disease?
Patients with adrenal causes of Cushing’s syndrome have low blood ACTHlevels and patients with the other causes of Cushing’s syndrome have normal or
high levels. A doctor can measure the level of ACTH in the blood; measuring
the ACTH levels helps to determine if the tumor is in the adrenal gland(s) or
elsewhere in the body.
The best test to distinguish an ACTH-producing tumor in the pituitary from
one in another part of the body is a procedure called inferior petrosal sinus
sampling, or IPSS. It is also possible to visualize the pituitary gland using a process called magnetic
resonance imaging (MRIIf However, up
to 10% of healthy people have an abnormal area on their pituitary consistent
with a tumor. Therefore, the presence of an abnormality alone is not diagnosti
What are the treatment options for Cushing’s disease
?1.The best way to cure the tumor is by surgically
Other options for treatment include radiation therapy to the entire pituitary2.
2.gland or targeted radiation therapy (called radiosurgery
3.medical treatment :
3.medical treatment : ketoconazole, metyrapone and/or occasionally mitotane.. Ketoconazole can damage the liver, so blood tests are done
to monitor liver function. Metyrapone can cause excess hair growth in women
and high blood pressure in both men and women. new medications
pasireotide, may act to both stop tumor growth and lower ACTH
production. Since it does not kill the tumor, it has to be given indefinitely. One
of the important side effects of pasireotide is that it can raise blood sugar levels;
therefore, blood sugar levels must be carefully monitored. Pasireotide is FDAapproved