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  • imageGlucocorticoid secretion from the adrenal cortex is stimulated by adrenocorticotropic hormone (ACTH) or corticotropin that is released from the anterior pituitary in response to the hypothalamic-mediated release of corticotropin-releasing hormone (CRH).

  • imageTo ensure the proper treatment of Cushing syndrome requires diagnostic procedures to (1) establish the presence of hypercortisolism and (2) discover the underlying etiology of the disease.

  • imageThe rationale for treating Cushing syndrome is to reduce the morbidity and mortality resulting from disorders such as diabetes mellitus, cardiovascular disease, and electrolyte abnormalities.

  • imageThe treatment of choice for both ACTH-dependent and ACTH-independent Cushing syndrome is surgery. Pharmacologic agents are reserved for adjunctive therapy, refractory cases, or inoperable disease.

  • imagePharmacologic agents that may be used to manage the patient with Cushing syndrome include steroidogenesis inhibitors, adrenolytic agents, neuromodulators of ACTH release, and glucocorticoid-receptor blocking agents.

  • imageSpironolactone, a competitive aldosterone-receptor antagonist, is the drug of choice in bilateral adrenal hyperplasia (BAH)–dependent hyperaldosteronism.

  • imageAddison disease (primary adrenal insufficiency) is a state of deficiency in cortisol, aldosterone, and various androgens due to the loss of function in all regions of the adrenal cortex.

  • imageSecondary adrenal insufficiency usually results from exogenous steroid use, leading to hypothalamic–pituitary–adrenal (HPA)–axis suppression followed by a decrease in ACTH release, and low levels of androgens and cortisol.

  • imageVirilism results from the excessive secretion of androgens from the adrenal gland and often manifests as hirsutism in females.



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  • Create a table with mechanisms for drug-induced secondary adrenal insufficiency


The adrenals are small endocrine glands located atop each kidney that produce several hormones that regulate blood pressure, metabolism, immune response, stress response, and other bodily functions. Under- or over-production of these hormones cause a constellation of symptoms and most commonly result in Cushing Syndrome (hypercortisolism), Addison’s disease (adrenal insufficiency), or hyperaldosteronism. Adrenal disorders affecting the hormone cortisol are rare, typically effecting fewer than 1 person in a thousand. On the other hand, aldosterone-related disorders, particularly hyperaldosteronism, are relatively common. Left untreated, complications from these disorders can include organ damage, physical manifestations, electrolyte abnormalities, cardiovascular crises, and even death. Thus, prompt identification and treatment is critical. Screening and management of these conditions lower the risk of complication, increase life expectancy, and improve quality of life for those affected.1


The adrenal glands are located on the upper poles of each kidney (Fig. 97-1). On average, each adrenal gland weighs 4 g and is 2 to 3 cm in width and 4 to 6 cm in length. The gland is fed by small arteries from the abdominal aorta and renal and phrenic arteries. Drainage of ...

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