Adrenocortical Excess

The Correct Answer is B. Cushing's syndrome


-is most commonly caused by the administration of pharmacological doses of glucocorticoids
-is less commonly caused by bilateral hyperplasia of the adrenal glands
-is called Cushing’s disease when it is caused by overproduction of ACTH (primary hypo-pituitary disease
-may also be caused by an ectopic ACTH producing non-endocrine tumor
is characterized by the following:

-1. Increased cortisol and androgen levels
-2. Increased ACTH (if caused by overproduction of ACTH);

decreased ACTH (if caused by primary adrenal hyperplasia or pharmacological doses of glucocorticosteroids)

-3. Hyperglycemia - diabetes (caused by elevated cortisol levels)
-4. Increased protein catabolism and muscle wasting
-5. Central/truncal obesity (round face – moon facies, supraclavicular fat, buffalo hump)
-6. Poor wound healing – lose collagen so skin is fragile, think and easily bruised
-7. Virilization of women (caused by elevated levels of adrenal androgens – think hairy, menstrual abnormalities)
-8. Hypertension (caused by elevated levels of cortisol and aldosterone)
-9. Osteoporosis (elevated cortisol levels cause increased bone resorption)

10. Striae – sides of lower abdomen

Diagnosis: 24 hour urine free cortisol level, which is increased, and loss of normal diurnal pattern of cortisol secretion.

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