Adrenal Glands Flashcards
What are adrenal glands?
Recap : The adrenal gland is an endocrine organ situated on top of its respective kidney and its divided in what are two functionally separate glands, cortex and medulla. The adrenal cortex is divided in three zones:
• Zona glomerulosa more externally which produces mineralocorticoids»_space; aldosterone.
• Zona reticularis close to the medulla which produces mostly sex steroids (DHEA)
• Zona fasciculata which is the thickest between the former two, making up 75% of the adrenal cortex. It produces glucocorticoids (principally cortisol)
The Adrenal Medulla is instead made of chromaffin cells which produce catecholamines (mainly epinephrine)
What is primary acute adenocortical insufficiency?
Aka adrenal crisis can be due to worsening condition in a chronic patient, rapid withdrawal of steroid or massive hemorrhage. Also because of Waterhouse friderichesn syndrome in children due to extensive bacteraemia.
What is primary chronic Adrenocortical Insufficiency?
aka Addison’s disease. Due to progressive deterioration of the renal tissue which can occur due to lymphomas, amyloidosis, sarcoidosis and infections. Clinically the patient will present fatigue, weakness and GI disturbances. More than 90% of cases are attributable to one of these four disorders : autoimmune adrenalitis, infections, metastatic neoplasms or genetic causes.
What is hypercortisolism?
Cushing Syndrome is a disorder in which there is elevated glucocorticoid levels. Can be caused by ACTH secreting pituitary adenomas.
What are the tumors of the adrenal glands?
Pheochromocytoma : It is a paraganglioma of the adrenal medulla. The term paraganglioma refers to tumors that arise outside the adrenal gland in structures that are chemoreceptors for oxygen, blood pressure, etc. These tumors secrete a lot of catecholamines, resulting in high hypertension. When managing these kinds of tumors, it is of utmost importance not to squeeze them. They have to be manipulated in a way to avoid a catecholamine storm. Indeed, the first procedure is usually to clamp the vessels and then manipulate the tumour
Myelolipoma : Rare, benign solitary tumor of mature fat cells.
General information on adrenal neoplasms?
Adenomas and carcinomas are equally common in adults, but carcinomas are more common in children. Adrenocortical adenomas are relatively frequent above the 50 years of age. They are present in 2% of the population and in 2/3 of the cases in women 30-40 yo.
What is hyperaldosteronism?
Generic term for all conditions characterized by chronic excess levels of aldosterone which mainly results in hypertension.
Can be caused by : bilateral idiopathic hyperaldosteronism characterized by nodular hyperplasia or Adrenocortical neoplasms.
What is secondary and tertiary Adrenocortical insufficiency?
Similar to Addison’s disease but is caused be caused by disorder pituitary gland like carcinoma, infection, infarction. Tertiary same thing but stemming from hypothalamus.
