Adrenal Cortex (path) Flashcards
8/5
Normal adrenal glands?
paired and located above upper pole of kidney
normal net +/- 4 gms
Right vs left adrenal gland
right triangular
left semilunar
Adrenal Cortex?
Zona glomerulosa- mineralcorticoids
Zona fasciculata- glucocorticoids
Zona reticularis- sex steroids (estrogen and androgen)
Adrenal medulla?
Chromaffin cells- catecholamines
Hypercortisolism (Cushing Syndrome)?
caused by increased amount of glucocorticoid
most commonly exogenous
Primary hypothalamic- pituitary dieases associated with increase secretion of ACTH
Hypersecretion of cortisol by adrenal adenoma
secretion of ectopic ACTH by a nonendocrine neoplasm
Pituitary Hypersecretion?
most common in young adults
most associated with ACTH-producing pituitary adenoma
adrenals are bilateral hyperplastic
Clin features of Hypercortisolism/ Cushing syndrome
Muscle weakness, thin extremities moon facies, buffalo hump, truncal obesity abdominal striae hypertension osteoporosis immune suppression
Primary adrenal neoplasms?
they are a small number 10-15% of endogenous Cushing Syndrome
adneomas and carcinomas are equally common in adults
Ectopic secretion?
about 10% of endogenous Cushing syndrome
most common in men 40-50s
small cell carcinoma of lung, carcinoid tumors of bronchus or pancreas, meduallary ca of thyroid, islet cell tumor of the pancreas
Hyperaldosteronism?
chronic excess aldosterone secretion
cause Na retention and K secretion
results in suppression of the renin angiotensis system and decrease levels of plasms renin activity
Cause of Hyperaldosteronism?
aldosterone producing neoplasm or by adrenocortical hyperpolasia
Conn syndrome?
solitary adenoma as the cause of Hyperaldosteronism, usually the case
Conn syndrome/ Hyperaldosteronism presents?
hypertension, hypokalemia, high serum aldosterone and low serum renin levels, aldosterone secreting adenoma (Conn’s syndrome)
Secondary Hyperaldosteronism?
response to activation of the renin-angiotensin system
high aldosterone, high renin
Primary Hyperaldosteronism?
Hypertension, hypokalemia (weakness, parathesias, visual disturbance, tetany), sodium retention incresae extracellular fluid volume, hypertension is in part secondary to sodium retention
Cause secondary Hyperaldosteronism?
decreased renal perfusion
arterial hypovolemia
pregnancy
Adrogenital syndromes?
primary gonadal or adrenal disorders may cause
virilzation in girls, precocious puberty in boys, all are autosomal recessive disorders
Waterhouse-Friderchesen Syndrome?
Uncommon but catastrophic syndrome
more often in children
not as many infections so not as common today
primary chronic adrenal insufficiency?
Addison disease uncommon autoimmune most common cause infectious disease can cause (TB, fungi) metastatic cause
Clincal symptoms of Addison’s disease?
weakness, fatigue, anroexia, hypotension, nausea/vomit, cutaneous hyperpigmentation
lab- high ACTH, hyperkalemia, hyponatremia, volume depletion
Secondary adrenocortical insufficency?
may be caused by any disorder of the hypothalamus or pituitary associated with decreased production of ACTH
distinguished from primary by abscence of hyperpigmentation, normal level of aldosterone
Adrenocortical neoplasms
Adenoma?
carcinoma?
poorly encapsulated
highly malignant, usually large at time of diagnosis, mets to lung
Cortical carcinoma
displaces kidney downward, functional neoplasm usually, secrete corticosteroids or sex steroids, poor prognosis
Adrenal medulla?
structure/ function different from cortex
neural crest cells- chromaffin cells
catecholamines
neuroendocrine cells similar to chromaffin cells are widely spread in extra adrenal systen and form the paraganlion system
most medullary disorders are neoplams
Pheochromocytoma?
associated with catecholamine production and hypertension
adrenal medulla
usually sporadically, some are familial
Rule of 10s
10% occur in children 10% are bilateral 10% occur outside the adrenal gland 10% are malignant 10% are familial (MEN II and MEN III)
Patient present with pheochromocytoma?
Episodic hypertension
