Anaesthesia in Adreno-cortical Hypereunction

PATIENTS WITH adreno-cortmal hyperfunctaon-are not frequently presented to anaesthetists. The proper anaesthetac management for adrenalectomy m these cases reqmres a basic understanchng of the physlopathology of the synch'omes caused by hyperfunetlon of the adrenal cortex. The adrenal cortex secretes three types of sterold hormones, file glucocorticolds, and the mmeralo-corticolds and hormones with androgenic and oestrogemc properties The majority of gluco-cortacolds are m the form of hydrocortasone and cortisone, hydrocortisone being the mare gluco~corticold secreted. These hormones have been called "S'" hormones because of their effect on carbohydrate metabohsm, resulting m a decreased tolerance to carbohydrate and an increased tolerance to insuhn Hydrocomsone and cortisone have also been labelled the anta-anabohc hormones since, b E &vetting amino-acids from gluconeo-genesls, they inhibit formatmn of body protein and eventually there is a marked deficmncy of body protem. The mmeralo-cortacolds regulate salt and water metabohsm Aldosterone wbach is the most important in man causes retention of sodium and elimination of potassmm The androgens and oestrogens ot the adrenal cortex contribute to the development of secondary sex characteristics. Excess of these steroids may lead to suppressrun of the gonad and distortion of secondary sexual development. There is no clear-cut sepmatmn of the bmlogieal activities of these hormones For example, androgens are salt retainers, but not nearly to the same degree as aldosterone Cortisone ~s a poor mmeralo-cortmold compared w~th aldosterone or even desoxy-cortmo-sterone acetate. Due to the overlapping of bmlogical achwty, it is therefore not surprising that patients with adreno-cortical hyperhmctton are often ddtlcult to categorize clinically. There are, however, three mare syndromes of adreno-cortaeal hyperhmction which can be attributed to the three groups of holznones produced by the adrenal. These are Cushing's s)rndrome, vmhzing adrenal hyperplasia and primary aldosteronism Overproduction of gluco-coltacoids results m Cushing's syndrome and can be produced in man by the achmnish'atmn of col~sone in large doses In Cushing's syndrome, the influence of gluco-cortmolds on carbohydrate metabolism is manifested clinically by hyperglycaemia and glycosuria, and these patients may be on fairly large doses of msuhn The ant~-anabolic effect of the gluco-corticoids.is manifested elinmally by thin skin, easy bruisability due to increased friability of the blood vessels, and delayed wound healing. Deficient