Adrenal Disorders: Cushing & Addison

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About Adrenal Disorders: Cushing & Addison

Adrenal disorders encompass a spectrum of conditions affecting cortisol production, with Cushing's syndrome representing excess cortisol and Addison's disease indicating cortisol deficiency. These conditions result from dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis and can be life-threatening if not properly diagnosed and managed.

Pathophysiology

Cushing's syndrome occurs due to prolonged exposure to elevated cortisol levels, commonly from pituitary adenomas (Cushing's disease), adrenal tumors, or exogenous corticosteroid use, leading to metabolic, cardiovascular, and immunologic dysfunction. Addison's disease results from primary adrenal insufficiency due to autoimmune destruction of the adrenal cortex, infections, or other causes, resulting in deficient cortisol and aldosterone production.

Clinical Reasoning

Cushing's syndrome presents with central obesity, purple striae, moon facies, buffalo hump, hypertension, and glucose intolerance, requiring dexamethasone suppression tests and imaging for diagnosis. Addison's disease manifests with fatigue, hyperpigmentation, hypotension, hyponatremia, and hyperkalemia, necessitating morning cortisol levels, ACTH stimulation tests, and immediate hormone replacement therapy to prevent adrenal crisis.

References

  1. Adrenal Insufficiency - StatPearls. StatPearls / NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK537260/
  2. Cushing Syndrome - StatPearls. StatPearls / NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK470218/
  3. Endocrine Society Guideline: Primary Adrenal Insufficiency. JCEM. https://doi.org/10.1210/jc.2015-1710
  4. Cushing Syndrome Diagnosis: Endocrine Society. JCEM. https://doi.org/10.1210/jc.2008-0125

Related Topics

Adrenal CrisisPituitary DisordersElectrolyte Disorders