What Is Hyperadrenocorticism?

Adrenal hyperfunction refers to different clinical syndromes caused by excessive secretion of one or more adrenal hormones. Excessive androgen production leads to adrenal virilization; excessive glucocorticoid production produces Cushing's syndrome; excessive aldosterone production causes hyperaldosteronism.

Adrenal hyperfunction

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Adrenal hyperfunction refers to one or more

Any syndrome, congenital or acquired, with excessive adrenal androgen production can cause virilization.

A group of clinical abnormalities caused by chronic exposure to excessive cortisol (mainly adrenocortical hormone) or related corticosteroids.

Etiology: Adrenal hyperfunction can be ACTH-dependent or ACTH-free, such as cortisol produced by adrenal adenoma or cancer. High physiological doses of exogenous cortisol or related synthetic similar drugs inhibit adrenal function There are simulated non-ACTH-dependent hyperfunctions. ACTH-dependent adrenal hyperfunction can be caused by: excessive pituitary ACTH secretion; non-pituitary ACTH-secreting tumors, such as small cell lung cancer (ectopic ACTH syndrome); or exogenous ACTH The term Cushing's syndrome applies to the clinical manifestations of hypercortisol caused by whatever cause (for whatever reason). Due to excessive pituitary ACTH, hyperadrenocortical function is called Cushing's disease, which means that there is a unique physiological abnormality. Patients with Cushing's disease can be pituitary basophils or chromocytoma.

Adrenal cortex symptoms and signs

Clinical manifestations include full moon face, multiple blood quality. Concentric obesity, prominent superior clavicle fossa and dorsal and neck fat pads (buffalo dorsal); distal limbs and fingers are often very slender, muscles are thin and weak. Skin is thin, atrophic, The wound is not easy to heal and is easy to bruise. Purple stripes are visible in the abdomen. High blood pressure, kidney stones, osteoporosis, impaired glucose tolerance, poor resistance to infection and mental disorders are common. Stopping linear growth is a characteristic of children. Women often have irregular menstrual periods Adrenal tumors, in addition to cortisol, increased androgen production can lead to hairy, temporal hair loss, and other virilizing signs in women.

Diagnosis of adrenal hyperfunction

In the morning (6-8 o'clock), the plasma cortisol is normally between 5-25 g / dl (138-690 nmol / L), and then gradually decreases until the evening (after 6 o'clock) <10 g / dl (L). Cushing Syndrome patients usually have elevated cortisol in the morning, lack of normal cortisol production during the day, and decreased plasma cortisol in the evening. The total cortisol production in 24 hours increases. A single plasma cortisol sample may be difficult to interpret because of the pulse type Secretion results in a wide range of normal values. Patients with congenital corticosteroid-binding globulin may have pseudo-elevation of plasma cortisol, but these patients have normal circadian rhythms. In patients with Cushing's disease, free cortisol is urine, and urine excretion is the highest. Good test [normal value is between 20 ~ 100g / 24h (55.2 ~ 276nmol / 24h)], patients with Cushing's disease increased by> 120g / 24h (> 331nmol / 24h), and obesity only increased slightly by <150g / 24h (< 414nmol / 24h).

Traditional dexamethasone test, dexamethasone 1mg, orally taken at 11-12 o'clock in the evening, and plasma cortisol measured at 7-8 o'clock in the morning, this method can be used as screening for Cushing's syndrome. This method is suitable for most normal people, In the morning, plasma cortisol is 5g / dl (138nmol / L), and most patients with non-pituitary Cushing syndrome have a morning cortisol level of at least 9g / dl (248nmol / L), and maintain plasma cortisol at the initial level.

Dexamethasone 0.5mg once every 6 hours for 2 days (small dose), ACTH secretion in normal people is suppressed. As a result, free cortisol in urine decreased to 50% or lower than before administration, but some patients decreased the next day To 10g / 24h (<27.6nmol / 24h). In patients with Cushing's disease, relative to dexamethasone inhibition, urine free cortisol will not normally decrease. Local dexamethasone 2mg is given once every 6 hours for 2 days (large Dose), urine free cortisol in patients with Cushing's disease is often at least 50% lower than the baseline value, because the disease depends on pituitary ACTH.