Summary about Disease
Unilateral adrenal hyperplasia (UAH) is a condition characterized by the enlargement of one adrenal gland while the other remains normal in size. This enlargement often leads to overproduction of certain hormones, most commonly cortisol, resulting in a form of Cushing's syndrome. It is considered a rare cause of Cushing's syndrome.
Symptoms
Symptoms of UAH are often similar to those of Cushing's syndrome and may include:
Weight gain, particularly in the face, neck, and abdomen
Fatigue
Muscle weakness
High blood pressure
High blood sugar (diabetes)
Easy bruising
Purple or pink stretch marks on the skin (striae)
Acne
Increased thirst and urination
Osteoporosis (weak bones)
Mood changes, such as depression or anxiety
In women: irregular menstrual periods, increased facial hair growth (hirsutism)
In men: decreased libido, erectile dysfunction
Causes
The exact cause of unilateral adrenal hyperplasia is not fully understood in all cases. In some instances, it may be related to:
Somatic mutations: Genetic mutations arising in the adrenal gland cells themselves.
Abnormal receptor expression: Alterations in the receptors on adrenal gland cells may cause an abnormal response to stimulation.
Unknown factors: In many cases, the underlying cause remains unknown.
Medicine Used
Medications are often used to manage the symptoms of hypercortisolism, either before surgery or in patients who are not surgical candidates. These include:
Ketoconazole: An antifungal medication that inhibits cortisol production.
Metyrapone: Inhibits cortisol synthesis.
Mitotane: A cytotoxic drug that can destroy adrenal gland cells (used in more severe cases).
Osilodrostat: Blocks cortisol synthesis.
Pasireotide: May be used if Cushing's is related to a pituitary tumor. Following adrenalectomy, hormone replacement therapy (e.g., hydrocortisone) is typically required to compensate for the loss of adrenal function.
Is Communicable
No, unilateral adrenal hyperplasia is not a communicable disease. It is not infectious and cannot be spread from person to person.
Precautions
There are no specific precautions to prevent unilateral adrenal hyperplasia as the cause is often unknown. However, managing risk factors for associated conditions like high blood pressure and diabetes is important. After adrenalectomy, patients need to adhere to their hormone replacement therapy and follow up with their endocrinologist.
How long does an outbreak last?
UAH is not an outbreak-related disease. It is a chronic condition related to an abnormality of the adrenal gland. The symptoms will persist unless the underlying cause of hormone overproduction is addressed.
How is it diagnosed?
Diagnosis of unilateral adrenal hyperplasia involves several steps:
Medical History and Physical Examination: To assess symptoms and medical history.
Hormone Testing: Blood and urine tests to measure cortisol levels, ACTH levels, and other hormone levels. Dexamethasone suppression tests are commonly used to evaluate the body's response to cortisol.
Imaging Studies: CT scans or MRI of the adrenal glands to visualize the size and shape of the adrenal glands and to identify any masses or abnormalities. Adrenal vein sampling may be done to measure hormone levels directly from the veins draining each adrenal gland.
Differential Diagnosis: Ruling out other causes of Cushing's syndrome, such as pituitary tumors, ectopic ACTH production, or bilateral adrenal hyperplasia.
Timeline of Symptoms
The timeline of symptoms can vary depending on the severity of hormone overproduction and the individual. The onset can be gradual, with subtle symptoms appearing over months to years. Some individuals may experience more rapid symptom development.
Important Considerations
Early Diagnosis: Early diagnosis and treatment are crucial to prevent long-term complications such as cardiovascular disease, diabetes, osteoporosis, and psychological problems.
Surgical Management: Adrenalectomy (surgical removal of the affected adrenal gland) is often the preferred treatment option for unilateral adrenal hyperplasia.
Hormone Replacement: After adrenalectomy, hormone replacement therapy (corticosteroids) is usually necessary to prevent adrenal insufficiency.
Follow-up Care: Regular monitoring by an endocrinologist is essential to manage hormone levels and prevent recurrence.
Multidisciplinary Approach: Management of UAH often involves a team of specialists, including endocrinologists, surgeons, and radiologists.