Adrenal Adrenal disordersdisorders

Steroid actionsSteroid actions

Amino acid catabolism (muscle wasting)… gluconeogenesis in the liver.. Hyperglycemia… increased insulin output… eventual beta cell failure… fat deposition… diabetes

Ca resorption, impairment of Ca absorbtion, increased renal Ca excretion…. osteoporosis

Increased gastric acidity… ulcer formation or aggravation K loss and Na retention… edema and hypertension Initially increased antibody release.. Eventually decreased

antibody production, lymphocytopenia, eosinopenia, neutrophelia, polycythemia… susceptibility to infections

Maintenance of arteriolar tone and blood pressure

Cushing’s SyndromeCushing’s Syndrome

Major Clinical Features in Cushing’s Major Clinical Features in Cushing’s SyndromeSyndrome

Weight gain, Central obesity Moon face and plethora Muscular weakness, especially proximal Malaise Depression and psychosis Oligomenorrhoea or amenorrhoea in females Hirsuties Striae, acne, skin-thinning, bruising Poluuria, nocturia decreased libido and impotence in males Hypertension diabetes or impaired glucose tolerance

Frequency of signs and symptoms in Frequency of signs and symptoms in Cushing’s syndromeCushing’s syndrome

Sign

or

symptom

Occurrence %

Sign

or

symptom

Occurrence %

Central obesity 94 Easy bruisability 60

Hypertension 82 Osteoporosis 60

Glucose intolerance 80 Personality changes

55

Hirsutism 75 Acne 50

Amenorrhea or impotency 75 Edema 50

Purple striae 65 Headache 40

Plethoric faces 60 Poor wound healing 40

Pre treatment Post treatment

Old picture

Adrenal InsufficiencyAdrenal Insufficiency

Causes of Adrenal Causes of Adrenal InsufficiencyInsufficiency

Primary Idiopathic (Addison disease) Tuberculosis Fungal infections Adrenal hemorrhage Congenital adrenal hypoplasia Sarcoidosis Amyloidosis Metastatic neoplasia Others

Causes of Adrenal Causes of Adrenal InsufficiencyInsufficiency

Secondary After exogenous glucocorticoids After the cure of Cushing syndrome

(removing endogenous glucocorticoids)

Hypothalamic and pituitary lesions

Major Clinical Features in Adrenal Major Clinical Features in Adrenal InsufficiencyInsufficiency

Weakness Skin

Mucous membrane and skin pigmentation, darkening of hair freckling, vitiligo, pigment accentuation at nipples, and friction areas, pigment concentration in skin creases and in scars

Loss of weight, emaciation, anorexia, vomiting, diarrhea

Hypotension Salt craving Hypoglycemic episodes

Congenital adrenal Congenital adrenal hyperplasiahyperplasia

HyperaldosteronismHyperaldosteronism

Renin Angiotensin SystemRenin Angiotensin System

Angiotensinogen

Angiotensin I

Angiotensin II Angiotensin III

aldosterone

Renin

Converting enzyme

(-)

Signs and labs of Signs and labs of hyperaldosteronismhyperaldosteronism

Hypertension Hypokalemia Urine potassium wasting Increased aldosterone Low renin

PheochromocytomaPheochromocytoma

Clinical manifestationsClinical manifestations

Intermittent hypertension or even hypotension headache 71%, palpitations 65%, sweating

65% and dizziness 15%, sense of doom Vomiting 28%, weakness 17%, nervousness

10%, pallor 16%, dyspnea 19%, substernal pain 12%, and abdominal pain 12%

Glycosuria neutrophelia

The EndThe End