Diverse presentation of diseases of the adrenal cortex

Abstract

Introduction: The adrenal glands are divided into cortex and marrow. The cortex secretes three different classes of hormones: glucocorticoids, mineralocorticoids and androgens; the marrow produces catecholamines. All of them are involved in multiple corporal functions.

Objective: Show different forms of presentation of some of the diseases of the adrenal cortex.

Presentation of cases: Patient 1: 7-year-old school boy, history of controlled hypothyroidism, and presenting decay and poor pondostatural growth. Cortisol level in fasting 86 nmol/L and ACTH 154 pg/ml. Primary adrenal insufficiency is diagnosed. Re-admitted at age 9 for maintaining little growth. Bone age: 2 years and 8 months. Clonidine test: altered, it confirms growth hormone deficiency. Patient 2: 8-year-old schoolboy, history of congenital adrenal hyperplasia due to 21 hydroxylase deficiency, simple virilizing form. He presents acceleration of genital development. Hydrocortisone treatment was missed for 5 years. 17 hydroxyprogesterone was found to be elevated to 189 ng/dl. Peripheral precocious puberty and virilization of the genitals were diagnosed. Patient 3: 5-month-old infant with obesity of 3 months of evolution. Contrasted computed axial tomography of the abdomen confirms tumor lesion of 5 cm in projection of the right adrenal. Cortisol level in fasting 892 nmol/L, cortisol 11 pm 920 nmol/L. Surgery was performed and Cushing's syndrome was diagnosed due to cortisol-producing adrenal carcinoma.

Conclusions: In daily clinical practice we can find patients with symptoms and signs as common as decay, vomiting or sudden weight gain and they are secondary to diseases of the adrenal gland.