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Physiological basis for the etiology, diagnosis, and treatment of adrenal disorders: Cushing's syndrome, adrenal insufficiency, and congenital adrenal hyperplasia
- Source :
- Comprehensive Physiology
- Publication Year :
- 2014
-
Abstract
- The hypothalamic-pituitary-adrenal (HPA) axis is a classic neuroendocrine system. One of the best ways to understand the HPA axis is to appreciate its dynamics in the variety of diseases and syndromes that affect it. Excess glucocorticoid activity can be due to endogenous cortisol overproduction (spontaneous Cushing’s syndrome) or exogenous glucocorticoid therapy (iatrogenic Cushing’s syndrome). Endogenous Cushing’s syndrome can be subdivided into ACTH-dependent and ACTH-independent, the latter of which is usually due to autonomous adrenal overproduction. The former can be due to a pituitary corticotroph tumor (usually benign) or ectopic ACTH production from tumors outside the pituitary; both of these tumor types overexpress the proopiomelanocortin gene. The converse of Cushing’s syndrome is the lack of normal cortisol secretion and is usually due to adrenal destruction (primary adrenal insufficiency) or hypopituitarism (secondary adrenal insufficiency). Secondary adrenal insufficiency can also result from a rapid discontinuation of long-term, pharmacological glucocorticoid therapy because of HPA axis suppression and adrenal atrophy. Finally, mutations in the steroidogenic enzymes of the adrenal cortex can lead to congenital adrenal hyperplasia and an increase in precursor steroids, particularly androgens. When present in utero, this can lead to masculinization of a female fetus. An understanding of the dynamics of the HPA axis is necessary to master the diagnosis and differential diagnosis of pituitary-adrenal diseases. Furthermore, understanding the pathophysiology of the HPA axis gives great insight into its normal control.
- Subjects :
- Cortisol secretion
medicine.medical_specialty
endocrine system
Hypothalamo-Hypophyseal System
Adrenal disorder
Pituitary-Adrenal System
Hypopituitarism
Article
Primary Adrenal Insufficiency
Internal medicine
medicine
Adrenal insufficiency
Humans
Congenital adrenal hyperplasia
Cushing Syndrome
Adrenal Hyperplasia, Congenital
Adrenal cortex
business.industry
medicine.disease
Endocrinology
medicine.anatomical_structure
business
Glucocorticoid
hormones, hormone substitutes, and hormone antagonists
medicine.drug
Adrenal Insufficiency
Subjects
Details
- ISSN :
- 20404603
- Volume :
- 4
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Comprehensive Physiology
- Accession number :
- edsair.doi.dedup.....a81b462afd9a03245404021e727843de