Hyperadrenalism and Adrenal Disorders: Clinical Summary

• Cortisol-secreting adrenal neoplasia
• ACTH-secreting ectopic tumor
• ACTH-secreting pituitary adenoma (Cushing disease)

Clinical Features

• Sudden weight gain
• Truncal obesity
• Buffalo hump
• Moon face
• Abdominal striae
• Plethora (red face due to superficial blood vessels)
• Hypertension
• Lab findings: Hypernatremia, hypokalemia, glucosuria

Diagnosis

1. Low-Dose Dexamethasone Suppression Test: 1 mg of dexamethasone administered at midnight. In healthy individuals, this suppresses ACTH and cortisol production. In Cushing syndrome, cortisol remains elevated.
2. Pituitary Adenoma: Indicated by cortisol suppression during the test.
3. No Response: If cortisol remains high, it suggests an ACTH-secreting tumor or adrenal neoplasia.
4. Differentiation: ACTH levels are normal in adrenal neoplasia and high in ACTH-secreting tumors.

Symptoms

• Hypertension, weakness, fatigue, polyuria, polydipsia, headache
• Lab findings: Hypernatremia, hypokalemia

Diagnosis & Treatment

• Diagnosis: Aldosterone-to-renin ratio (ARR > 23.6 indicates primary hyperaldosteronism) and abdominal CT.
• Treatment: Spironolactone and adrenalectomy.

Overview

Characterized by hypocortisolism (loss of cortisol). Causes include autoimmune conditions or acute adrenal insufficiency.

Symptoms & Labs

• Salt craving, orthostatic hypotension, weakness, weight loss, hyperpigmentation, amenorrhea, and low blood pressure.
• Lab findings: Hyponatremia, hyperkalemia, and metabolic acidosis.

Diagnosis & Treatment

• Diagnosis: Stabilizing the patient and performing a Cosyntropin Stimulation Test.
• Treatment: Preventative care to avoid adrenal crises. Replace glucocorticoids (cortisol) and mineralocorticoids (fludrocortisone). Increase prednisone dosage during illness.