Adrenal Cortical Disorders
Disorders of the adrenal cortex involve the excess or deficiency of corticosteroids: glucocorticoids (cortisol), mineralocorticoids (aldosterone), and androgens.
1. Hyperfunctional Syndromes
| Syndrome | Excess Hormone | Clinical Hallmarks |
|---|---|---|
| Cushing Syndrome | Cortisol | Moon facies, buffalo hump, purple striae, and hypertension. |
| Conn Syndrome | Aldosterone | Hypertension, hypokalemia, metabolic alkalosis. |
| CAH | Androgens | Virilization, salt-wasting (if 21-hydroxylase deficiency). |
2. Hypofunctional States
- Addison’s Disease (Primary Adrenal Insufficiency): Destruction of all adrenal cortical layers. Leads to low cortisol, low aldosterone, and high ACTH.
- Buzzword: Skin hyperpigmentation (due to elevated MSH—a byproduct of pro-opiomelanocortin/ACTH).
- Waterhouse-Friderichsen Syndrome: Acute adrenal insufficiency due to massive hemorrhage (classically associated with Neisseria meningitidis).
Pathology Board Hint: Remember: Cushing Syndrome is excess cortisol (any cause); Cushing Disease is specifically an ACTH-secreting pituitary adenoma. For Addison, always look for the hyperpigmentation—this distinguishes it from secondary adrenal insufficiency (pituitary failure), where ACTH is low, and pigmentation is normal.