The diagnosis and treatment of these disorders are outlined in this issue. Disorders of the adrenal cortex are characterized by deficiency or excess of one or several of the three major corticosteroid classes. Of note, female bias is not only observed among adrenal hypersecretion diseases, but also among patients with Addisons disease caused by adrenal hypofunction. The expressions of hypofunctional syndromes include Addison's disease and selective hypoaldosteronism. Clinical expressions of hyperfunctional adrenocortical syndromes include Cushing's syndrome, primary hyperaldosteronism, and the adrenogenital syndrome. The disorders of the adrenal cortex can be viewed from the dual perspectives of hyperfunction and hypofunction.

The anatomic configuration of the adrenal cortices is delineated by high-resolution computed tomography (and magnetic resonance imaging), obviating the need for invasive procedures such as venography or arteriography. These dynamic studies enable the clinician to evaluate the functional status of the adrenal cortex. As in other endocrinopathies, suppression studies are employed when hyperfunction is suspected, while provocative tests are used to detect hypofunction. The availability of sensitive and specific radioimmunoassays has permitted accurate measurement of practically every steroid hormone secreted by the adrenal cortex. The adrenal glands are controlled in part by the brain. Of these three classes of steroids only the gluco- and mineralocorticoid hormones are necessary to sustain life. The adrenal cortex is functionally a three-dimensional gland that secretes glucocorticoids, mineralocorticoids, and sex steroids.

Disorder of adrenal cortex