An excess of cortical hormones,
hydrocortisone (or cortisol) and corticosterone
Aetiology
Adenoma or carcinoma of the adrenal
cortex
Hyperplasia secondary to excess ACTH
(60% of cases)
Pituitary tumours
Other ACTH producing tumours, (ectopic
production) (15% of cases)
Steroid therapy (most commonly seen
form)
Diagnosis
Plasma hydrocortisone levels
Hormones found in the urine - 24 hour
urine collections
Increased blood sugar diabetes
Reduced blood potassium
Reduced eosinophils
Possible glycosuria
Features
Tumours of the adrenal cortex produce
androgens
In children
Precocious puberty Affected
growth rate
In females
Masculinization - male hair
distribution, breast reduction deeper voice, clitoris enlargement
Irregular and scanty periods, reduced
libido
Adults
Buffalo hump Heavy
trunk thin extremities - weight gain
Thin skin Rounded
face
Muscle catabolism – weakness Osteoporosis
Mental changes/psychosis Hypertension
Oedema - puffy face Sodium
retention potassium loss
Management
Drugs to reduce cortex activity or
hormone synthesis (metyrapone)
Give potassium as prescribed, titrated
from blood results
Low sodium diet - cereals, fruits,
potatoes
High potassium - legumes, vegetables
Make physical observations
TPR BP
Psychological/psychiatric observations
Irradiation of pituitary tumour
Surgery to remove cause
Follow surgery with replacement
therapy
Under activity of the adrenal cortex
Causes
Autoimmunity (80% of cases)
Tuberculosis (20% of cases)
AIDS
Destruction/removal of adrenal cortex
Atrophy of cortex eg following steroid
therapy
Haemorrhage into gland during
septicaemia
Steroid withdrawal especially if
sudden
Features
Pigmentation of skin and mouth due to effect
of ACTH of melanocytes
Weight loss
Low sodium - chronic dehydration
Low blood pressure - tachycardia
High potassium
Muscular weakness
Gastrointestinal problems - anorexia,
nausea, vomiting, pain
Low blood sugar
Psychotic problems eg. depression
Diagnosis
Low urine levels of hormones - 24 hour
collection
Low plasma hormone levels
Hypoglycaemia
Hyponatraemia
Hyperkalaemia
Management
Try to restore electrolyte balance
Give IVT containing fluid and sodium
High sodium, low potassium diet
Hydrocortisone replacement therapy
Observation of TPR and BP
IV hydrocortisone and normal saline
for Addisonian crisis - low BP and collapse
Fluid balance chart
Protect from infection