ADRENAL GLAND

CUSHING SYNDROME

Main causes -

Hypersecretion due to increased ACTH (Cushing disease)

Adtrenal oversecretion due to adenoma or Carcinoma

Secretion of ectopic ACTH

Administration of exogenous corticosteroids

MORPHOLOGY

Pituitary- Crooke hyaline change

Adrenal- Cortical atrophy, diffuse or nodular hyperplasia, adenoma and rarely carcinoma

DIAGNOSIS

Increased 24 hour urinary free cortisol level

Loss of normal diurnal pattern of cortisol secretion

Dexamethasone suppression test used for determining cause of cushing syndrome

CAUSES OF ADRENOCORTICAL INSUFFICIENCY

Adrenocortical Insufficiency

primary insufficiency

Loss of Cortex

Congenital adrenal hypoplasia

X-linked adrenal hypoplasia (DAX1 gene on Xp21)

"Miniature"-type adrenal hypoplasia (unknown cause)

Adrenoleukodystrophy (ALD gene on Xq28)

Autoimmune adrenal insufficiency

Autoimmune polyendocrinopathy syndrome type 1 (AIRE1 gene on 21q22)

Autoimmune polyendocrinopathy syndrome type 2 (polygenic)

Isolated autoimmune adrenalitis (polygenic)

Infection

Acquired immune deficiency syndrome

Tuberculosis

Fungi

Acute hemorrhagic necrosis (Waterhouse-Friderichsen syndrome)

Amyloidosis, sarcoidosis, hemochromatosis

Metastatic carcinoma

Metabolic Failure in Hormone Production

Congenital adrenal hyperplasia (cortisol and aldosterone deficiency with virilization)

Drug- and steroid-induced inhibition of ACTH or cortical cell function

secondary insufficiency

Hypothalamic Pituitary Disease

Neoplasm, inflammation (sarcoidosis, tuberculosis, pyogens, fungi)

Hypothalamic Pituitary Suppression

Long-term steroid administration

Steroid-producing neoplasms