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Internal Medicine
4. Diseases of the adrenal gland
Learning objectives: at the end of this lesson the student will be able to:
1. Define different types of diseases of the adrenal gland.
2. Describe the pathophysiology of diseases of the adrenal gland.
3. Identify the clinical manifestation of diseases of the adrenal gland, with special emphasis
on Cushing’s syndrome and Addison’s diseases.
4. Understand the diagnostic approach of diseases of the adrenal gland.
5. Manage patients with common diseases of the adrenal gland.
Common Adrenal gland diseases
1. Disease of the adrenal cortex
a) Resulting from excess production of hormones
Cushing’s syndrome : excess cortisol production
Primary hyperaldosteronism : excess production of aldosteron
b) Inadequate production ;
Addison’s diseases : inadequate production of cortisol and aldosteron
2. Disease of the adrenal medulla
Pheochromocytoma: excess production of catecholamine
Cushing’s Syndrome ( Hypercortisolism)
Cushing’s syndrome: is caused by excessive concentration of cortisol or other glucocorticoid
hormones in the circulation
a) Bilateral adrenal hyperplasia (Cushing’s diseases) is the commonest cause of
Cushing’s syndrome. It is caused by increased pituitary secretion of ACTH. Pituitary
tumors large enough to be seen by skull x-ray, are present in more than 10 % of these
patients, and smaller basophilic adenomas are found in more than 50 % of patients.
b) Adrenal adenomas and adrenal carcinoma may produce excess cortisol