DISEASE OF ADRENAL GLANDS Flashcards
OUTLINE DISEASES OF ADRENAL CORTEX
ADRENAL HYPERFUNCTION
ADRENAL INSUFFICIENCY/ HYPOADRENALISM
> acute
> chronic
ADRENOCORTICAL TUMORS
WHAT IS HYPOADRENALISM?
Decreased secretion of adrenocortical hormones
Can be: > primary > secondary > acute > chronic
ETIOLOGY OF PRIMARY ACUTE ADRENOCORTICAL INSUFFICIENCY
SEPTICIEMIA - DIC
MENINGIOCOCCEMIA - WATERHOUSE FRIDERICHSEN SYNDROME
BILATERAL ADRENALECTOMY
CORTICOSTEROIDS
DESCRIBE PATHOGENESIS OF CORTICOSTEROIDS ON ADRENAL INSUFFICIENCY
Corticosteroids suppress pituitary secretion of ACTH > through negative feedback
Atrophy of adrenal cortex
low secretion of cortisol
sudden demand for cortisol
ACUTE ADRENOCORTICAL INSUFFICIENCY
DESCRIBE PRIMARY CHRONIC ADRENOCORTICAL INSUFFICIENCY?
ADDISONS DISEASE > decreased adrenal cortisol
> opposite to CUSHINGS
> defect in adrenal gland
normal hypothalamus and pituitary gland > CRH + ACTH
ETIOLOGY OF PRIMARY CHRONIC ADRENOCORTICAL INSUFFICIENCY
ADDISON'S DISEASE > auto immune disorder > Ab against adrenal cortex cells > malignancies > TB infections > infarction/ haemorrhage > amyloidosis > fungal disease
CLINICAL FEATURE OF PRIMARY CHRONIC ADRENOCORTICAL INSUFFICIENCY
> insufficiency of adrenal hormones
aldosterone, cortisol, androgens
> hypovolemia > hypotension > tachycardia > weight loss > malaise > skin hyper pigmentation > loss of body hair > menstrual irregularities > low libido
OUTLINE ION IMABLANCE IN PRIMARY CHRONIC ADRENOCORTICAL INSUFFICIENCY
low mineralocorticoids - ALDOSTERONE
> increases excretion of Na + increased retention of potassium
> hypovolemia + hypotension
> loss of Na > hyponatrenemia
> increased potassium > hyperkalemia acidosis
» muscular weakness + ECG abnormality
HOW IS ADDISONS DIAGNOSED?
ACTH LEVEL TEST
> CORTISOL LEVEL LEADS TO NEGATIVE FEEDBACK LOOP
> HIGH CORTISOL > NEGATIVE FEEDBACK ON HYPOTHALAMUS TO SECRETE LESS CRH + ACTH
> LOW CORTISOL > means no negative feedback loop
ACTH CONTINUED TO PRODUCE
HIGH ACTH + LOW CORTISOL
PROBLEM
DESCRIBE MORPHOLOGY OF ADRENAL GLAND IN ADDISON
> adrenal cortex > loss of normal three layered structure
adrenocrotical cells > reduced to islets
surrounded by increased fibrous tissue + lymphocytic infiltration
WHAT IS SECONDARY ADRENOCORTICAL INSUFFICIENCY
WHEN THERE IS DECREASED FUNCTION OF ADRENAL CORTEX DUE TO DYSFUNCTION IN THE HYPOTHALAMUS OR PITUITARY GLAND
ETIOLOGY OF SECONDARY ADRENOCORTICAL INSUFFICIENCY
> destructive lesions of pituitary gland
destructive lesions of hypothalamus
prolonged corticosteroid therapy
OUTLINE CLINICAL FEATURES OF SECONDARY ADRENOCORTICAL INSUFFICIENCY
> LOW ACTH in blood
> no skin hyper- pigmentation
DESCRIBE TUMORS OF ADRENAL GLANDS
> CAN BE:
- adrenocortical tumor
- medullary tumor
Adrenal tumors are rare but most common site for metastasis eg from lung cancer
WHICH IS THE MOST COMMON PRIMARY TUMOR OF ADRENAL GLANDS?
CORTICAL ADENOMA
> slow growing bening tumor
> small
> non functional
MULTUPLE ENDOCRINE NEOPLASIA TYPE 1
