PATHOPHYSIOLOGY OF

Precipitating Factors
 Obesity

Hypersecretion of CRH by
benign tumor of hypothalamus

Excessive secretion of
ACTH by pituitary gland

↑ Serum ACTH

↑ Stimulation of cortisol
synthesis

HYPERCORTISOLISM

↑ Appetite Altered Fat ↑Stimulation of glucose Promotion ↑ protein

Metabolism formation in the liver breakdown

Mobilization of
Fatty Acid ↑Glucose production
in the liver Amino acid mobilized and ↑ Protein
transferred to the liver catabolism

Fat Deposition Converts cell Exhaustion of B cells

metabolism from Protein wasting
Use for glucose
use of glucose to
production
use of Fatty acid ↓ Insulin (gluconeogenesis)
production

Peripheral
glucose use falls Insulin resistance

Hyperglycemia

Around the waist face Back of the head

(Truncal obesity) (Moonface) (Buffalo Hump) DIABETES
MELLITUS

In skin In muscles & extremities In blood vessel wall In bone

↑ Serum plasma protein level

C U S H I N G’S S Y N D R O M E
Predisposing factors
 Age: 10 y/o

↑sterilization of lysosomal Depressed

membrane of inflammatory cells phagocytosis by WBC

Prevents the release of ↓ Release of inflammatory

↑ serum plasma inflammatory mediators mediators
protein level (prostaglandin, leukotrienes)

Inhibits inflammatory
Proteinuria reaction

↓ or absence of fever

↑ Susceptibility to
infection

Atrophy of lymphoid tissues

↓ B lymphocytes ↓ T lymphocytes
 Thin skin Rupture with Osteoporosis
Thin arms & Muscle minimal trauma
legs weakness

Stretch marks
Back pain

Compression
fracture

Inhibits fibroblast activity enhancement of

vasoconstrictive effect of
circulatory
catecholamine

Lessen scar formation

Vasoconstriction of
blood vessel
Poor wound healing

Hypertension

Skin ulcers
 ↓ Antibody ↓ humoral ↓ Cell mediated
formation immunity immunity

↓ Immune response

↑Stimulation of Aldosterone synthesis ↑ Stimulation of Melanin Synthesis

Hyperpigmentation of skin and gums

Hyperaldosteronism

Purpura
Altered diurnal secretion ↑ Na & H20
of aldosterone retention

Disturbed sleep
Weight gain ↑ Serum Na ↓Serum K ↑Blood volume
Sleep deprivation
Polydipsia Hypokalemia ↑ Blood Pressure

Hypertension