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Adrenocortical hyperfunction — Clinical Guidelines

Overview

Adrenocortical hyperfunction, including Cushing's syndrome, involves excessive production of cortisol or other adrenal hormones, leading to a variety of clinical signs and symptoms across different organ systems. 3

Diagnosis

Clinical Signs: Pruritus, pyoderma, alopecia, and facial dermatosis are common presentations, particularly in veterinary cases 1 5.

Laboratory Tests: Elevated alkaline phosphatase (though not consistently elevated in all cases) and other endocrine panel abnormalities are indicative 1.

Imaging and Biopsy: Not explicitly detailed in provided abstracts but often used in comprehensive evaluation 3.

Management

First-Line Treatments:

- Veterinary: Mitotane or trilostane for dogs with hyperadrenocorticism 1. - Human: Not detailed in abstracts, but typically includes ketoconazole, metyrapone, or adrenalectomy depending on etiology 3.

Adjunctive Treatments:

- Skin Conditions: Antimicrobials for secondary infections, topical glucocorticoids for inflammation 1. - Voice Hyperfunction: Techniques like modified "silent" yawn-sigh for vocal tract relaxation 4.

Special Populations

Veterinary Focus: Specific considerations for dogs, including facial dermatosis as a unique presentation 5.

Human Populations: No specific details provided in abstracts regarding pregnancy, pediatrics, or elderly management 3.

Key Recommendations

Evaluate for Pruritus and Skin Lesions in suspected cases of adrenocortical hyperfunction, particularly in veterinary patients (Evidence: Moderate 1).

Consider Comprehensive Endocrine Panels including alkaline phosphatase levels, though interpret with caution due to variable elevation (Evidence: Weak 1).

Utilize Targeted Therapies such as mitotane or trilostane for veterinary hyperadrenocorticism, and tailor human treatments based on underlying cause (Evidence: Expert opinion 1 3).

References

1 Bloomer A, Diesel A, Griffin CE, Griffies J. Retrospective Case Series of Patients with Hyperadrenocorticism Presenting to a Referral Dermatology Practice. Journal of the American Animal Hospital Association 2025. link 2 Giovanni A, Akl L, Ouaknine M. Postural dynamics and vocal effort: preliminary experimental analysis. Folia phoniatrica et logopaedica : official organ of the International Association of Logopedics and Phoniatrics (IALP) 2008. link 3 Honour JW. The investigation of adrenocortical disorders. Journal of the International Federation of Clinical Chemistry 1995. link 4 Boone DR, McFarlane SC. A critical view of the yawn-sigh as a voice therapy technique. Journal of voice : official journal of the Voice Foundation 1993. link80114-6) 5 White SD. Facial dermatosis in four dogs with hyperadrenocorticism. Journal of the American Veterinary Medical Association 1986. link

Adrenocortical hyperfunction