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Let us Learn about the Disorders of Adrenal Cortical Hormones.
Due to Hypo secretion of Glucocorticoids/Cortisol:
(A) Addison’s disease:
Thomas Addison (1855) first described this disease. It occurs due to hypo secretion of cortical glucocorticoids. It may be due to bilateral tubercular destruction or due to tubercular infection or due to autoimmune diseases. The clinical features are as follows:
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(i) Anatomical features (Fig. 12.6):
1. There is increased melanin pigment synthesis in skin and shows bronze in colour.
2. Diseased person shows muscular weakness.
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3. Oedema occurs due to loss of water from the capillaries.
(ii) Physiological features:
1. Gastro-intestinal disturbances and vomiting occurs.
2. There will be fall of blood pressure.
3. Blood pressure becomes lowered.
4. Metabolic rate is reduced.
5. Subnormal body temperature (below 96°C).
6. Depressed glycogenesis and gluconeogenesis.
7. NaCI is excreted in greater quantity.
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8. Potassium is retained.
9. Disturbances is ionic balance.
(iii) Psychological features:
1. Ionic disturbances may cause lack of mental concentration.
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2. Patient shows restlessness.
3. Shows insomnia.
(iv) Sexological features:
1. Sexual activities are reduced.
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2. Both primary and secondary sex characters are ill developed.
Due to Hyper Secretion of Glucocorticoids:
Cushing’s syndrome:
H. Cushing (1932) first described this disease; Excess glucocorticoids secretion takes place due to adrenocortical tumours. Pituitary tumour may cause over secretion of ACTH which in-turn causes hyperplasia of cortex.
The clinical features are as follows:
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(i) Anatomical features (Fig. 12.7)
1. Excessive body hair growth (hirsutism)
2. Osteoporosis occurs due to decalcification of bones.
3. Face becomes round due to accumulation of fat.
4. Presence of buffalo hump on the back of neck.
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5. Skin shows purple striate over the abdomen.
6. Obesity takes place.
7. Slow wound healing
8. Wasting of muscles occurs in the limbs.
Physiological features:
1. Blood sodium level becomes increased but potassium level decreases.
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2. Polyuria and polydipsia occur.
3. Hyperglycemia occurs.
4. Loss of protein takes place from bony matrix.
5. Lipogenic effect occurs.
(iii) Psychological features:
1. Patients are mentally deranged.
2. Hypertension takes place.
(iv) Sexological features:
1. Female shows masculinization with the development of male secondary sex characters, like growth of beard, mustaches, under developed mammary glands etc.
2. Males suffer from impotence and atrophy of testes.
Hyper secretion of Mineralocorticoids/ Aldosterone:
Conn’s Syndrome:
Conn (1955) first described this disease. This disease is caused by hyper secretion of aldosterone. Adrenal tumour or adrenal carcinoma may lead to the formation this disease.
The clinical features are as follows:
(i) Anatomical features:
1. Muscular weakness develops due to loss of K+.
2. Bones become fragile.
3. Cirrhosis of liver.
(ii) Physiological features:
1. Increased renal distal tubular excretion of potassium and hydrogen.
2. The reabsorption of sodium increases.
3. Loss of hydrogen may cause alkalosis.
4. Congestion of cardiac vessels may cause cardiac failure.
(iii) Psychological features:
1. May cause severe hypertension.
2. Mental disturbances occur.
Due to Hyper secretion of Adrenocortical Androgen:
Adrenogenital Syndrome:
Adrenocortical androgen is secreted from the zone reticularis of adrenal cortex. Hyper secretion is associated with tumours in the adrenal cortex. It occurs in both male and female and shows sex reversals. The syndrome may be congenital in childhood or acquire in adult stage.
(i) Adrenal virilism:
It occurs in adult females which lead to appearance of masculine characters like
1. Appearance of masculine voice.
2. Growth of moustache and beard.
3. Hirsutism occurs.
4. Menstruation becomes highly irregular.
5. Ovary becomes degenerated.
6. Sterility develops.
7. Mammary glands reduce in size.
(ii) Adrenal feminization:
It occurs in male and leads to appearance of feminine characters:
1. Development of feminine voice.
2. Beard and moustache are fallen off.
3. Body hair scanty.
4. Penis ill developed.
5. Growth of breasts occurs.
6. Testis become reduces.
7. Loss of sex desire.
(iii) Congenital adrenogenital syndrome:
Hyper secretion of cortical androgen before puberty may cause this syndrome in male and female.
In male:
1. Early development of testes.
2. Secondary sex characters appear before maturity.
In female:
1. Development of breast in early age.
2. Sometimes masculine external genitalia appears.
Disorders of Adrenal Medullary Hormone:
(i) Pheochromocytomas:
It is a tumour may arise within adrenal medulla or chromaffin cells, very specifically within sympathoadrenal system.
The common clinical symptoms are:
1. Severe hypertension.
2. Sweating.
3. High BMR.
4. High O2 consumption.
5. Constipation.
6. Psychosis.
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7. Cold hand and feet.
8. Tremulousness.
9. Visual disturbance.
10. Nausea and vomiting.
11. Abdominal or chest pain.
12. Fatigue or exhaustion.
Competitive inhibitors of tyrosine hydroxylase, such as α-methyl tyrosine, are often effective in treatment of pheochromocytoma.
(ii) Hypo function:
Hypo function of adrenal medullary hormones is very rare. Disturbance in autonomic nervous system may cause hypo secretion of epinephrine. The patient has orthostatic hypotension and hypoglycemia.
(iii) Hyper function:
Hyper function of adrenal medullary hormones may cause following symptoms:
1. Increased blood pressure.
2. Increased cardiac output.
3. Increased renin secretion from kidney.
4. Increased level of angiotension II in circulation.
