Lecture 4 - Pathology Flashcards
What are the layers of the adrenal cortex?
Glomerulosa (outmost layer) - produces mineralocorticoids under RAAS regulation
Fasiculata and reticularis - produce and store fluocorticoids and sex steroids – controlled by ACTH regulation
Medulla - catecholamine production
What are the 2 different types of adrenal disorders?
Morphological
Functional
Adrenal Hyperplasia
bilateral disease
glands are equally enlarged on both sides
if ACTH excess – this is limited to zona fasciculata and retinularis
Adrenal Adenoma
solitary nodules, yellow
may or may not be functional disorder
incidental finding d/t imaging for something else
if its functioning and producing glucocorticoids –there will be atrophy of surrounding cortex
What are the NIH guidelines for incidental adrenal adenomas? (nodules)
if >6cm –> absolute remove
if <6cm –> monitor
if the nodule is hormonally active take it out
what people actually do is >4.5 cm remove!
Adrenal cortical carcinoma
rare
50% hormonally active
typically very big d/t retroperionteal space prevents you from feeling it grow and grow since there are no other organs to compress it and thus cause sxs
bimodal age: peds and >50y/o
poor prognosis –resistant to chemo
What are types of morphological adrenal disorders?
hyperplasia
adenoma
carcinoma
When are glucocorticoids highest?
highest on waking
lowest in early sleep
What are the clinical findings of Cushing’s syndrome?
obesity HTN poor wound healing hyperglycemia hypokalemia alkalosis (d/t cortisol excess) hirsutism menstrual problems (d/t androgen excess)
moon face
buffalo hump
What causes cushing’s disease?
over production of ACTH in pituitary
What is the difference between cushings syndrome and disease?
syndrome is d/t ectopic ACTH production usually from SCC tumor in the lung
Adrenal Insufficiency
might result in mineralocorticoid deficiecny or glucocorticoid deficiency
Mineralocorticoid deficiency
dehydration
decrease in Na+
increase in K+
metabolic acidosis
Glucocorticoid deficiency
weakness
weight loss
vomiting
hypoglycemia
Primary Adrenal Insufficiency
Addison’s disease
lack cortisol and aldosteron
increase ACTH which causes abnormal pigmentation
What causes secondary adrenal insufficiency?
only lack of glucocotricoids
____% of the CORTEX must be destroyed to have insufficiency
> 90%
destruction occurs via infection or autoimmune disease
What are the main causes for destruction of the cortex?
infection in developing worlds
autoimmune disorders in Western world
Waterhouse - Frederichesen
adrenal hemorrhagic necrosis due to gram negative sepsis (often meningococcal)
Adrenogenital Syndrome
enzyme defect of the adrenal gland –abnormal hormone synthesis
inherited deficiency
usually the 21B hydroxy enzyme is missing
decrease in cortisol –> increase in ACTH –> hyperplasia
What determines external genital development?
androgen —> female
if you have excess androgen you will have male-ish or ambiguous genitalia
Which drugs stimulate the release of Epi in the adrenal medulla?
clonidine
ACEI
CCB
What drugs inhibit the release of Epi in the adrenal meduall?
MAOI
Neuroblastoma
childhood malignant tumor of the adrenal medulla
