Hyperadrenalism
Hyperadrenalism Causes
The abnormally high levels of cortisol in hyperadrenalism patients are caused by a number of factors ? including pituitary adenoma (as in Cushing's disease), adrenal hyperplasia or neoplasia, ectopic adrenocorticotropic hormone (ACTH) production, and iatrogenic. Cortisol is commonly released from the adrenal gland in response to the pituitary gland releasing ACTH.
Hyperadrenalism Definition
Hyperadrenalism, more commonly known as Cushing's Syndrome, is an endocrine abnormality marked by the presence of high cortisol levels in the blood. Hyperadrenalism is also often called hypercortisolism or hyperadrenocorticism. Its more familiar moniker, ?Cushing's Syndrome?, is attributed to Harvey Cushing, an American physician who is credited for its discovery and consequent study. According to the results of Cushing's studies, the disease is characterized by abnormal fat deposition. It also occurs commonly in dogs and domestic horses. In particular, Cushing's syndrome occurs when the adrenal cortex is invaded with a tumor and particularly deficient ACTH levels.
Hyperadrenalism Diagnosis
A dexamethasone suppression test may be done to test for Cushing's. This entails administering dexamethasine, a type of glucocorticoid that simulates the effects of cortisol. A 24-hour urinary analysis for cortisol also produces more or less the same results. Of course, vigilant monitoring of cortisol and ACTH levels must be done. Very recently, the US FDA approved a new diagnostic approach where the cortisol is sampled in saliva over 24 hours. When any of these clinical tests turn out positive, the adrenal gland must undergo CT scanning. In addition, an MRI must be taken of the pituitary gland to determine any adrenal or pituitary adenomas.
Hyperadrenalism Symptoms and Signs
Individuals suffering from hyperadrenalism typically show rapid weight gain, specifically of the trunk and face but excluding the limbs, resulting in central obesity. A round face (known in pop lingo as ?moon face?), excessive perspiration, and dilation of capillaries (or telangiectasia) are also signs of this disorder. Additionally, hyperadrenalism patients show susceptibility to easy bruising (skin thinning). A number of reddish or purple striae appear on the upper body, buttocks, limbs or breasts. The hip and shoulder (proximal) muscles also become weak, plus patients may also demonstrate facial male-pattern hair growth (known as hirsutism). Another common symptom is the development of fat pads near the collar bone and at the back of the neck (or lipodystrophy). In addition, excessive cortisol levels may affect the endocrine systems, thus causing insomnia, decreased libido, impotence in men, amenorrhoea and even infertility. Psychological disturbances, from mild euphoria to extreme pyschosis, are also common. Most huperadrenalism patients exhibit depression and anxiety.
Hyperadrenalism Treatment
Cushing's syndrome patients must stop any or all steroid medication. If an adrenal adenoma is present, it can be removed surgically. Corticotrophic pituitary adenoma, which secretes ACTH, must be removed once a diagnosis is made. Most patients will need steroid replacement for the short or long-term. For those who are unsuitable for surgery, some drugs are available to inhibit cortisol production. However, their efficacy is limited. In the absence of a tumor, adrenals may still be removed to stop an overproduction of cortisol. If this happens, replacement with hydrocortisone or prednisolone must be done as well.