1. MLAB 2401: Clinical Chemistry Keri Brophy-Martinez
Disorders of the Adrenal Gland

2. Addison’s Disease What is it?
Atrophy or destruction of adrenal cortex (PRIMARY)
Idiopathic
Autoimmune adrenalitis
Tuberculosis
Adrenal insufficiency (SECONDARY)
Hypothalamic/pituitary disease

3. Clinical Features: Addison’s Disease
Laboratory
Manifestations
Decreased cortisol levels
Both serum & urine
Decreased aldosterone
Increased ACTH
> 200 pg/mL
Increased skin pigmentation
Tiredness
Intestinal issues
Hypotension
Hypoglycemia
Hyperkalemia
Hyponatremia/hypocholoremia
Loss of body hair
Depression

4. Increased pigment of skin
Addison’s Disease
Pituitary
Increased MSH
Increased pigment of skin
Increased ACTH
No inhibition of ACTH
Shrunken Adrenal Cortex
Low cortisol
Low Aldosterone

5. Cushing’s Syndrome Caused by: Excess glucocorticoid production
Cortisol-secreting adrenal carcinoma or adenoma
Prolonged exogenous steroid use
iatrogenic

6. Laboratory Features Increased serum cortisol Hyperglycemia
Lack of diurnal variation of cortisol
Hyperglycemia
Sunheimer, R., & Graves, L. (2010). Clinical Laboratory Chemistry. Upper Saddle River: Pearson

7. Cushing’s Syndrome Manifestations Weight gain in face and abdomen
Buffalo hump back
Muscle wasting/weakness
Easy bruising
Hypertension
Osteoporosis
Hyperglycemia

8. Conn’s Syndrome Caused by:
Aldosterone-secreting adrenal adenoma of adrenal cortex (Primary)
Disorders within the renin-angiotensin system (Secondary)

9. Clinical Features: Conn’s Syndrome
Laboratory
Manifestations
Low serum potassium
High serum sodium
High aldosterone levels
Acid/base imbalances
Muscle weakness
Increased urination
Hypertension

10. Adrenal Medulla Disorders
Pheochromocytoma
Benign or malignant tumors in the adrenal medulla
Causes hypertension
Neuroblastoma/Ganlioneuromas
Common malignant tumors in pediatric patients

11. Disorders of Sexual Development

12. Testosterone Hyperandrogenemia Hypoandrogenemia
Increased testosterone production
In females: hirsutism ( see next slide)
Due to tumors in hypothalamus, testicles, or congenital adrenal hyperplasia
Hypoandrogenemia
Decreased testosterone production
Due to infections, tumors, congenital disorders, or decreased function of pituitary/ hypothalamus

13. Hirsutism Abnormal, abundant, hair growth( lip, chin, side burn, neck)
Loss of female sex characteristics
Ethnic origin important
Italians, eastern europeans, eastern Indian, Irish

14. hCG & Human placental lactogen
Increased
Hydatidiform mole, choriocarcinoma, pre-eclamptic toxemia
Decreased
Threatened abortion, ectopic pregnancy
Human placental lactogen
Normal to rise throughout gestation
Decreased levels suggest placental malfunction or fetal distress

15. Estrogen Hyperestrinism Overproduction of estrogen Females Males
Early puberty
Infertility & irregular menses
Postmenopausal bleeding
Males
Testicular atrophy
Breast enlargement

16. Estrogen Hypoestrinism Decreased production of estrogen
Ovarian insufficiency
Delayed puberty
Amenorrhea
Turner Syndrome

17. Progesterone Hyperprogesteronemia Hypoprogesteronemia
Prevents menstrual cycle
Hypoprogesteronemia
Results in infertility
Abortion of fetus

18. Menstrual Cycle Abnormalities
Average cycle is 28 days
Menopause between years
Amenorrhea
Absence of menses
Primary: never menstruated
Secondary: Had at least one menstrual cycle
Oligomenorrhea
Irregular menses
Cycle length in excess of days
Menorrhagia
Uterine bleeding > 7 days

19. References
Bishop, M., Fody, E., & Schoeff, l. (2010). Clinical Chemistry: Techniques, principles, Correlations. Baltimore: Wolters Kluwer Lippincott Williams & Wilkins.
Sunheimer, R., & Graves, L. (2010). Clinical Laboratory Chemistry. Upper Saddle River: Pearson .