Adrenal Disorders 9 Flashcards
What is primary adrenal failure called?
Addisons disease
What is excess cortisol known as?
Cushings disease
Where does the left adrenal drain into?
Left Renal vein
Where does the right adrenal drain into?
IVC
What can be easily damaged during a left adrenolectomy?
The spleen
Name all the layers of the adrenal (inwards out)
Medulla, z. Reticularis, Z. fasciculata, Z. glomerulosa
How is the medulla accessed by the many exterior arteries (e.g. superior superrenal artery)
Medullary arterioles supply the medulla and the cortex is supplied by cortical capillaries
What does the adrenal cortex produce?
- cortisol
- aldosterone
- sex steroids
What are the 3 main groups of hormones?
- peptides (ACTH)
- steroids (Sex hormones)
- amines (adrenaline/nor…)
What does the glomerulosa produce?
aldosterone
What does the medulla produce?
Adrenaline
What does the reticularis produce?
Small amounts of androgens e.g. testosterone
What does the fasciculata produce?
Cortisol
Describe the hypothalamo-pituitary-adrenal axis for Cortisol
1) Hypothalamus produces Corticotrophin-releasing Hormone
2) Pituitary synthesis POMC
3) POMC cleaved to form ACTH
4) ACTH acts on the fasciculata of the adrenals to produce Cortisol
5) Cortisol has -ve feedback on both the hypothalamus as well as the pituitary
What is POMC cleaved into?
ACTH. MSH and endorphins.
What causes Addisons Disease?
- autoimmune factors
- Tubercolosis
What are the features of Addisons Disease?
- Increased pigmentation (e.g. skin, hair, gums)
- autoimmune vitiligo
- Low bp
- loss of weight/anorexia/vomiting/diarrhea
- Muscular weakness (proteolysis)
- Salt Loss
What is the for Addisons Disease?
- Firstly, rehydrate with saline
- Give dextrose for hypoglycaemia
- Give hydrocortisone (to replace cortisol)
What are the features of excess Cortisol?
- Impaired glucose tolerance ( T2 diabetes)
- weight gain
- Thin skin/easy brusing
- striae
- Proximal Myopathy
- Mental changes
- hypertension
- Fat redistribution
- Moon face
- Interscapular fat pad
What are the four causes of Cushings Syndrome? (Decreasing prevalence)
1) Steroids orally
2) Pituitary adenoma with Increased ACTH (Cushings Disease)
3) Ectopic ACTH
4) Adrenal adenoma/carcinoma
What is Conns Syndrome?
An Aldosterone Producine Adenoma.
This is a tumor of the zona glomeruloa leading to increased aldosterone production. Therefore, there is hypertension, oedema and low blood K+
What are some of the side effects of steroid use (glucocorticoids)?
- hypertension
- diabetes
- osteoporosis
- reactivation of infection
- easy bruising
- poor wound healing
- thin skin
