adrenal 2 Flashcards
hyperadrenalism is caused by
caused by overproduction of 3 major hormones of the adrenal cortex
- Cushing’s syndrome - hypercortisolism
- conn syndrome - hyperaldosteronism
- adrenogenital or virilising syndrome - androgens
Cushing syndrome is
hypercortisolism
excess glucocorticoid levels - regardless of underlying cause
two routes of development of Cushing’s syndrome
exogenous - iatrogenic administration
- corticosteroids used as anti-inflammatory agent in numerous diseases
endogenous - ACTH indépendant or dépendant
ACTH independent endogenous cushings syndrome
- adrenal cortical adenoma
- adrenal cortical carcinoma
- primary cortical hyperplasia - sporadic condition in adults (relatively uncommon), inherited condition in children (McCune Albright syndrome (GNAS mutation))
ACTH dependant endogenous cushings syndrome
ACTH drives hyperplasia of cortex, i.e.secondary hyperplasia
- cushing disease (ACTH secreting pituitary adenoma)
- ectopic ACTH syndrome - eg. small carcinoma of the lung
Cushing syndrome symptoms
Cataracts Ulcers Striae, skin thinning Hypertension, hirsutism Imunosupression Necrosis of femoral heads Glucose elevation Osteoporosis, Obesity Impaired wound healing Depresson/mood changes
adrenal changes in exogenous glucocorticoids
suppression of endogenous ACTH leads to bilateral cortical atrophy
adrenal changes in ACTH-dependant Cushing syndrome
increased stimulation (due to increased ACTH from pitiuitary or ectopic site) leads to bilateral hyperplasia
adrenal changes in ACTH-independant Cushing syndrome
adrenal neoplasm (unilateral) cortical hyperplasia (unilateral or bilateral)
adrenal cortical hyperplasia
not neoplastic
often forms nodules - nodular hyperplasia
adrenocortical adenoma
common
benign neoplastic proliferation of cells of the adrenal cortex
usually incidental, usually middle aged adults but may occasionally occur in childhood
well circumscribed (nodular)
often non functional
if functional, may be associated with atrophy of the non-neoplastic gland
usually yellow to brown cut surface
proliferation of cells similar to those of the adrenal cortex
adrenocortical carcinoma
rare
malignant neoplastic proliferation of calls of the adrenal cortex
bimodal distribution in children and middle age
may be functional or non functional
larger, invasive lesions of metastasis is only way to be sure of malignancy
usually variegated appearance with areas of necrosis and haemorrhage
criteria suggesting that an adrenocortical carcinoma is malignant
- mitotic rate >5 per 50 high power fields
- cytoplasm (clear cells comprising 25% or less of the tumour)
- abnormal mitosis
- necrosis
- capsular invasion
hyperaldosteronism
excess aldosterone secretion, leads to retention of sodium and loss of potassium, leads to hypertension
primary hyperaldosteroneism
autonomous overproduction
- bilateral idiopathic- bilateral adrenal hyperplasia
- neoplasm - adenoma (conn syndrome) or carcinoma
- rare - glucocorticoid remediable - familialgenetic mutation placing aldosterone production under ACTH control
