Adrenocortical Hyperfunction



What is Adrenocortical Hyperfunction?

This is caused by an excessive production of glucocorticoids from the adrenal cortex. It produces typical symptoms characterised by overweight (of a special distribution), elevated blood pressure, reduced glucose tolerance, a rapid breakdown of body protein, cessation of periods in women and an increased risk of infections.

It may occur at any age, but is more likely in the third and fourth decades. It is more common in women. In many cases the gland is overactive because there is an excess amount of ACTH in the blood coming from over activity in the pituitary gland in the brain.



In turn, this may be caused by a tumour in this region. In other cases there is a growth on the adrenal gland itself, so causing the excessive activity. This may be an adenoma (noncancerous growth) or a carcinoma (cancerous growth). A certain number of growths can occur in other parts of the body and produce ACTH, quite unrelated to the normal endocrine system. The most common is cancer of the lungs, pancreas gland and ovaries.

Adrenocortical Hyperfunction Symptoms

Adrenocortical hyperfunction symptoms may be produced with the prolonged over administration of ACTH and related compounds. This lends weight to the nature of its cause. The disease comes on gradually over a period of many months, and it may even date back to pregnancy. Overweight may be the original complaint.



There may be menstrual irregularities, facial pimples (acne), facial hair in the female, or impotence (inability to gain or maintain an erection) in the male. General muscular weakness and bruising are common. There may be symptoms related to blood pressure or diabetes. Sometimes menstruation ceases entirely. Mental disturbances are relatively common, usually depression, and this may be the original complaint of the patient.

The patient tends to develop a typical appearance. The face tends to be rounded, and dramatically different when compared to old photos. The complexion is purplish. Women may show acne, and hair on the upper lip and jaw. While the limbs tend to be slender, the body is usually plump and obese. The skin is thin and wrinkles easily. Purple marks develop around the hips, abdomen and flanks. Bruises are in evidence, and the blood pressure elevated. There may be signs of an enlarged heart consequent to this. The key points to alert the doctor are the typical obesity of the trunk, absence of periods, pimples and facial hair in women.



Diagnosis, however, can test the ingenuity of the doctors. First it is necessary to establish that there is an excessive secretion from the adrenal cortex. Second, and probably more difficult, is to discover the underlying cause, for this can radically affect the subsequent therapy.

Excess corticosteroids may be produced by growths in other areas, as already mentioned, quite unrelated to the endocrine system. Discovering these can be a marathon task. However, many tests are available, and these may be used to help form a definitive diagnosis. It can be seen that with so many major difficulties, problems of this nature must be referred to endocrine specialist centres. These are often attached to the major hospitals. There is no place for self-diagnosis and treatment in these disorders.



Adrenocortical Hyperfunction Treatment

If a growth is present on the adrenal gland, it must be surgically removed. This is often the treatment of choice when the glands arc enlarged and overproduce from other causes. However, each case will have a specific routine worked out in an effort to give the best possible beneficial results.

Unless treated, Cushing’s syndrome usually ends fatally within five years. This often results from heart disease, diabetes or the effect of undercurrent infections. If adrenal cancer is the cause, the outlook is poor, for by the time surgery is undertaken, the cancer will most probably have spread to other sites (metastases).



However, in those with a noncancerous adenoma or simple hyperplasia (increased glandular activity from whatever cause), the end result may be good. After removal, the patient undertakes regular therapy with replacement cortisone-type drugs. Often deep pigmentation of the skin may occur, but this is a small price to pay for relatively good health once more.