Adrenal Glands; Adrenal Medulla, Adrenal Cortex Cushing Syndrome, Addison Disease

Question 1

What is a Pheochromocytoma?

Answer 1

benign tumour of the adrenal medulla that secretes epinephrine, norepinephrine and sometimes other substances

Question 2

How many Pheochromocytoma may there be and where may they originate?

Answer 2

occasionally there are multiple tumours
or tumour originates in sympathetic ganglia
may be bilateral or unilateral

Question 3

Pheochromocytoma is a relatively … tumour, but it is one of the “…” causes of ^HTN if it is diagnose.

Answer 3

rare
“curable”

Question 4

SnS; Pheochromocytoma:

Answer 4

headache
heart palpitations
sweating
intermittent and constant anxiety

• related to elevated BP

Question 5

What is frequently released intermittently by Pheochromocytoma and what symptoms do these result in?

Answer 5

catecholamines
sudden ^HTN and severe headache

Question 6

Cause: Adrenal Cortex Cushing Syndrome:

Answer 6

caused by excess of glucocorticoids (e.g. hydrocortisone and cortisol)

adrenal adenoma
pituitary adenoma
cushings disease
ectopic carcinoma that causes paraneoplastic syndrome
iatrogenic conditions e.g. admin of large glucocorticoids for many chronic inflammatory conditions

Question 7

paraneoplastic syndrome

Question 8

What are corticosteroids ?

Answer 8

steroid hormones produced in the adrenal cortex of vertebrates

essential for stress response and important bodily functions

wh

Question 9

Why is prolonged use of tx with corticosteroids drugs not recommended?

Answer 9

produce many unfortunate effects

Question 10

Changes associated with prolonged corticosteroids?

Answer 10

change appearance , moon face, heavy turn, buffalo hump, wasting muscle limbs

fragile skin, red streaks, ^hair growth (hirsutism)

catabolic effects - osteoporosis, decreased protein synthesis = delayed healing

metabolic changes ^gluconeogenesis, insulin resistance, may = glucose intolerance = DM/acerbate existing

retention Na and H20, (mineralocorticoid effect) = ^HTN, oedema, possible hyperkalaemia

suppression of IS and Inflamm response with atrophy of lymphoid tissue, predisposing client to infection

stimulation of erythrocyte production

emotional liability and euphoria

Question 11

What two concerns will health cares have about Cushings?

Answer 11

risk infection - local/sytemic e.g. tb

decreased stress response w iatrogenic cushings as atrophy adrenal cortex

Question 12

What may be done to treat decreased stress response in a pt with iatrogenic Cushings?

Answer 12

doses of meds increased before and during a stressful event; similarly ; dosage gradually reduced over a period of time to permit resumption of normal sensors function by the gland

tx also depends on underlying cause

Question 13

Addison Disease

Answer 13

deficiency of adrenocortical secretions, glucocorticoids, mineralocorticoids, androgens

Question 14

Patho; Addisons Disease;

Answer 14

autoimmune reaction common cause
gland destroyed by heamorrhage w meniingococcal infection, by viral, tubercular, histoplasmosis infections

destructive tumours may also = hypoacitvity

Question 15

SnS;Addisons Disease:

Answer 15

decreased blood glucose levels
poor stress response
fatigue
weight loss
frequent infections
low serum Na conc. decreased blood vol, hypoTN, accompanied by high K lvls - result mineralcorticoid (aldosterone) deficit cardiac arrhythmia and failure

decreased body hair, due lack androgens
hyperpigmenations in extremities, skin creases, buccal mucosa and tongue

comparison of cushings and Addison’s - table 16.6

Question 16

Tx; Addisons Disease:

Answer 16

replacement therapy with necessary hormones controls the disease
increased dose may be required at time of stress