CUSHING

Dr Putra Hendra SpPD

UNIBA
Adrenal Histology
Regulation
of adrenal
gland ACTH

secretion

Cortisol
Cortisol
Aldosterone Functions
 Functions of the aldosterone ANP
:escape

phenomeno
Plasma
(1) Tubular reabsorption of

Na+

Tubular secretion of K+ Na+

or H+ K+

(Kaliuresis)

(2) Hypokalemia & muscle

paralysis EC F volume
(3) Increase tubular H+
Blood pressure

secretion alkalosis

(4) Tekanan darah

 Steroid actions
Amino acid catabolism (muscle wasting)
gluconeogenesis in the liver.. Hyperglycemia
increased insulin output eventual beta cell failure
fat deposition diabetes
Ca resorption, impairment of Ca absorbtion, increased
renal Ca excretion. osteoporosis
Increased gastric acidity ulcer formation or
aggravation
K loss and Na retention edema and hypertension
Initially increased antibody release.. Eventually
decreased antibody production, lymphocytopenia,
eosinopenia, neutrophelia, polycythemia
susceptibility to infections
Maintenance of arteriolar tone and blood pressure
 Adrenal Medulla:
A Modified Sympathetic
Ganglion

Figure 11-10: The adrenal medulla

 Catechalomines: Activity
Stimulates the fight or fight
reaction
Increased plasma glucose levels
Increased cardiovascular function
Increased metabolic function
Decreased gastrointestinal and
genitourinary function
 ADRENAL GLAND
DYSFUNCTION
1. Hypercortisolism= Cushings
Syndrome
2. Hypocortisolism= Addisons
Disease
3. Conn syndrome
4. Pheochromocytoma
 Alterations of Adrenal
Function
Disorders of the adrenal cortex
Cushing disease
Excessive anterior pituitary secretion of
ACTH
Cushing syndrome
Excessive level of cortisol, regardless of
cause

12
 Addison's disease: Affects about 1 in 100,000
people; caused by adrenal in-sufficiency (90%);
typical by auto-immune disorders; both cortisol and
aldostertone hormones are lacking.

Cushing's disease: Affects about 10 to 15 million

people / yr; caused by adrenal hyper-activity
(cortisol); typical because of tumor growth,
exposure to prednisone for asthma, rheumatoid
arthritis, lupus or other inflammatory diseases
Conn's syndrome: May affect 15% of patients with
high blood pressure; caused by hyper production of
aldosterone; inability of adrenal cortex to carry out
17-hydroxylation; hypertension, loss of potassium
in the urine, muscle weakness and passing of large
volumes of urine (polyuria)
 CUSHINGS SYNDROME
Caused by excessive secretion of corticotropin
by anterior pituitary corticotroph
tumors(microadenomas)

Increased aldosterone, cortisol and testosterone

in the adrenal cortex

Signsand symptoms: hypertension,

hypokalemic alkalosis, hyperglycemia,
hypernatremia, osteoporosis, easy bruising,
polyuria, buffalo hump, moon facies, excessive
body hair, menstrual abnormalities, weight
gain, skeletal muscle wasting/weakness,
depression and insomnia
 Diagnosis
24 hour urinary secretion of cortisol
Dexamethasone suppression test
distinguishes Cushings disease from
the ectopic corticotropin syndrome
 Zona Fasciculata: Cushings Disease
hypersecretion of glucocorticoids
caused by hypersecretion of ACTH due to tumor
in ZF, pituitary, lungs, kidneys, or pancreas
suppresses glucose metabolism resulting in
hyperglycemia (elevated glucose= steroid
diabetes),
stimulates lipid metabolism (weight loss),
loss of muscle and bone mass,
buffalo neck and moon face (fat
redistribution),
anti-inflammatory effects (mask infection)
water and salt retention (effect of aldosterone
 Hypo- & Hyper- Cushings Syndrome
Function of the
Adrenal Cortex
Adrenal Anatomy

From: Bramwell, 1892

Atlas of Clinical Medicine
Addisons Disease http://www-medlib.med.ut
Weakness, fatigue ah.edu/WebPath/jpeg4/END
Unintended weight loss O003.jpg
Hyperpigmentation
Hypotension
Salt craving
Hypoglycemia
Nausea, emesis, diarrhea
Irritability www.bmb.leeds.ac.uk/teaching/
Depression icu3/ lecture/21/Image82.gif
Major Clinical Features in Cushings
Syndrome
Weight gain, Central obesity
Moon face and plethora
Muscular weakness, especially proximal
Malaise
Depression and psychosis
Oligomenorrhoea or amenorrhoea in females
Hirsuties
Striae, acne, skin-thinning, bruising
Poluuria, nocturia
decreased libido and impotence in males
Hypertension
diabetes or impaired glucose tolerance
 Treatment of choice

1. transsphenoidal
microadenomectomy

2. 85-90% resection of the

anterior pituitary gland