Adrenal gland disorders

• The fetal adrenal gland has an additional cortex which atrophies after birth. • Postnatally, there are three zones to the cortex: ◦ glomerulosa producing mineralocorticoids ◦ fasciculata producing cortisol ◦ reticularis producing androgens. • Adrenarche is a maturation process from age 6 years with an increase in androgens. • Acute adrenal crisis presents with: ◦ low sodium ◦ high potassium ◦ cortisol low/undetectable. • ACTH raised in primary causes, low in secondary. • Primary insufficiency may be congenital dysplasia (adrenal hypoplasia congenita) and enzyme blocks: congenital adrenal hyperplasia (CAH). • Acquired causes include autoimmune adrenalitis (Addison’s disease) and tuberculosis. • Secondary insufficiency arises due to adrenocorticotropic hormone deficiency from hypopituitarism (congenital or acquired). • CAH, e.g. 21-hydroxylase deficiency (commonest), can present with virilization of a newborn female, hyperandrogenism, or salt-wasting adrenal crisis. • Iatrogenic treatment is commonest cause of adrenal steroid excess. • Other causes are adrenal adenoma/carcinoma (Cushing syndrome) or pituitary adenoma (Cushing disease).