DISEASES OF THE ENDOCRINE SYSTEM SUPRARENAL GLAND DR HEYAM AWAD FRCPATH

SUPRARENAL GLAND ADRENAL GLAND…. CORTEX, AND MEDULLA

ADRENAL CORTEX SYNTHASIZESVTHREE HORMONE : 1. glucocorticoids , e.g: cortisol 2. mineralocorticoids, aldosterone 3. adrenocortical androgens

HYPERADRENALISM CUSHING SYNDROME HYPERALDOSTERONISM VIRILISING SYNDROMES

CUSHING SYNDROME CUSHING CAN RESULT FROM EXOGENOUS OR ENDOGENOUS CAUSES EXOGENOUS ARE THE MOST COMMON ENDOGENOUS DUE TO…HYPOTHALAMIC_PITUITARY DISEASE, ADRENOCORTICAL DISEASE OR ECTOPIC ACTH AS A PARANEOPLASTIC SYNDROME

HYPOTHALAMIC_ PITUITARY MOST COMMON ENDOGENOUS CAUSE 3RD TO 4TH DECADES, FEMALES MORE THAN MALES DUE TO PITUITARY ADENOMA OR HYPERPLASIA, OR HYPOTHALAMIC OVERPRODUCTION OF CRH

ADRENOCORTICAL CAUSES ACTH INDEPENDENT HYPERPLASIA, ADENOMA OR CARCINOMA

CUSHING CAUSED BY ECTOPIC ACTH SMALL CELL CARCINOMA OF THE LUNG CARCINOID, ISLET CELL TUMOUR OF PANCREAS, MEDULLARY CARCINOMA

MORPHOLGY EXOGENOUS.. ATROPHY OF ADRENALS ENDOGENOUS EXTRA- ADRENAL CAUSES… BILATERAL CORTICAL HYPERPLASIA ADRENAL CAUSES… CHANGES DEPEND ON THE CAUSE……. HYPERPLASIA, ADENOMA, CARCINOMA

CLINICAL FEATURES HYPERTENTION WEIGHT LOSS AT THE BEGINNING LIPID DISTRIBUTION CHANGES CAUSING .. TRUNCAL OBESITY, MOON FACE, BUFFALO HUMP DECREASED MUSCLE MASS AND WEAKNESS HYPERGLYCEMIA GLUCOSUIA POLYDYPSIA LOSS OF COLLAGEN AND BONE RESORPTION OSTEOPOROSIS INFECTIONS… LOW IMMUNITY MENTAL DISTURBANCES HIRSUTISM AND MENSTRUAL ABNORMALITIES

HYPERALDOSTERONISM SODIUM RETENTION AND POTASSIUM EXCRETION CAUSING HYPERTENTION AND HYPOKALEMIA PRIMARY AND SECONDARY CAUSES

PRIMARY CAUSES HYPERPLASIA ADENOMA…MOST COMMON CAUSE = CONN SYNDROME CARCINOMA REDUCED PLASMA RENIN

SECONDARY CAUSES DECREASED RENAL PERFUSION ARTERIAL HYPOVOLEMOA AND EDEMA PREGNANCY INCREASED RENIN

CLINICAL FEATURS HYPERENTION HYPOKALEMIA

ADRENOGENITLA SYNDROMES CONGENITAL ADRENOCORTICAL HYPERPLASIA… AUTOSOMAL RECESSIVE ADRENOCORTICAL NEOPLASMS

ADRENAL INSUFFICIENCY PRIMARY … ACUTE AND CHRONIC SECONDARY… DECREASED ACTH.. HYPOPITUITARISM

ACUTE ADRENOCORTICAL INSUFFICIENCY SUDDEN WITHDRWAL OF LONG TERM CORTICOSTEROID THERAPY STRESS IN PATIENTS WITH UNDERLYING CHRONIC ADRENAL INSUFFICIENCY MASSIVE ADRENAL HEMORRHAGE …. DUE TO ANTICOAGULANT THERAPY, DIC, SEPSIS

CHRONIC ADRENAL INSUFFICIENCY ADDISON DISEASE PROGRESSIVE DESTRUCTION OF ADRENAL CORTEX 90% OF THE CORTEX COMPROMISED TO HAVE SYMPTOMS 75_ 90% CAUSED BY AUTOIMMUNE ADRENALITIS 50% ASSOCIATED WITH OTHER AUTOIMMUNE LIKE DM, HASHIMOTO..

OTHER CAUSES OF ADDISON INFECTIONS : TB, AIDS, FUNGAL METASTASIS USUALLY FROM LUNGS AND BREAST

CLINICAL MANIFESTATIONS PROGRESSIVE WEAKNESS GI DISTURBANCES HYPERPIGMENTATION IF PRIMARY CAUSES DUE TO HIGH ACTH HYPOTENTION HYPOGLYCEMIA

ADRENAL MEDULLA DERIVED FROM THE NEURAL CREST CHROMAFFIN CELLS MOST COMMON DISEASES ARE NEOPLASMS

PHEOCHROMOCYTPMA ORIGINATE FROM CHROMAFFIN CELLS CORRECTABLE FORM OF HYPERTENTION SECRTEVCATECHOLAMINES

10% RULE FAMILIAL BILATERAL MALIGNANT EXTRAADRENAL… PARAGANGLIOMAS

CLINICAL PICTURE HYPERTENTION PALPITATION SWEATING TREMOR HEART FAILURE