Cushings syndrome

Pituitary Embryology
and
Anatomy

Pituitary - ACTH

proopiomelanocortin precursor
melanotropins, lipotropins and Bendorphin
circadian rhythm peaks am,
Stimulus: stress, hypoglycemia,
feed back : glucocorticoids in
circulation
Action: adrenal cortex secrete
glucocorticoids, lesser aldosterone

Adrenal Gland

cortex
zona glomerulosa

mineralocorticoids- aldosterone

zona fasciculata

glucocorticoids- cortisol

zona reticularis

androgens- estrogen, progesterone,

testosterone

medulla
norepinephrine, epinephrine

Adrenal Gland Physiology

zona glomerulosa
renin JG cell

respond to Na, and volume

angiotensinogen > angiotensin I

angiotensin I > angiotensin II by ACE
angiotensin II potent pressor >
aldosterone
hyperkalemia promotes independently
hypokalemia inhibits
ACTH

Adrenal
Gland Physiology
zona fasciculata
ACTH as
discussed
cortisol actions

zona reticularis

ACTH controls
no feedback
adrenarche

Hyperadrenocorticis
m

cushings syndrome
3rd - 6th decade, 4 to1
females
causes

Pharmocologic : steroid
pituitary adenoma
adrenal adenoma,
carcinoma
ectopic ACTH

treatment based on cause