Adrenal gland disorders Dr. Miada Mahmoud Rady EMS/474 Endocrinal emergencies

Introduction Supra renal gland or adrenal gland are paired gland located at the upper pole of the kidneys. It is divided into two parts an outter cortex and inner medulla , each secretes a different set of hormones. Main function of the hormones secreted by adrenal glands are : Cortisol → Sugar → increase BMR using fat and protein for energy.

Introduction Aldosterone → Salt → Na and water reabsorption (↑ Na ) , K excretion ( ↓ K ). Androgens→ Sex → sex hormones . Adrenaline and noradrenaline → Stress→ stimulates sympathetic nervous system . 4 S

Hypothalamopituitary adrenal axis Hypothalamus secretes CRF. Which stimulate anterior pituitary to secretes ACTH. Which stimulate adrenal cortex to secrete cortisol.

Cortisol Assist with the response to stress. Maintain blood pressure and cardiovascular function. Regulates the metabolism of carbohydrates, proteins, and fats. Regulates glucose levels by balancing the effects of insulin. Slows the inflammatory response.

Adrenal dysfunction So abnormal adrenal cortical function produces: Abnormalities in the metabolism of carbohydrates and protein. Disturbances in salt and water metabolism.

Adrenal insufficiency Definition : decreased function of the adrenal cortex . It may be Primary Or Secondary . Decreased in hormone production result in : Weakness. Dehydration. Impaired body ability to maintain adequate blood pressure and respond to stress.

Primary Adrenal Insufficiency Also known as Addison's disease . It is caused by Decreased Function of The Adrenal Cortex and consequent underproduction of cortisol and Aldestorone. Clinical presentation: Slow progressive onset (over several months) . The symptoms are usually well tolerated except in crises .

Clinical Presentation Hypotension and salt craving . Hypoglycemia . Hyper pigmentation (skin pigmentation ). Weakness . Weight loss. Fatigue . Fainting . Pain (musculoskeletal ) which is so sever during crises. Diarrhea which is so marked during crises.

Secondary Adrenal Insufficiency More common than the primary type.??? Caused by : lack of adrenocorticotropic hormone (ACTH) secretion from the pituitary gland. Sudden withdrawal of chronic corticosteroid therapy. About 25% of patients first experience symptoms during an addisonian crisis.

Secondary Adrenal Insufficiency Clinical presentation : The same as primary adrenal insufficiency except: Chief clinical manifestation is shock. Hypoglycemia is more sever. Gastrointestinal symptoms are less common. Darkening of the skin and dehydration do not occur.

Addisonian crises symptoms Sudden, severe pain in back and abdomen. Severe vomiting and diarrhea. Dehydration (marked). Hypotension and shock. Syncopal attack and finally coma. Can be fatal.

Laboratory Finding Decreased serum cortisol . Hyponatremia . Hyperkalemia . Hypoglycemia .

Management of Addisonian Crises Maintain ABCs : Maintain patent airway , guard against vomiting and be ready for suction. Advanced airway management may be indicated. Maintain adequate oxygenation and ventilation Follow the procedure for altered mental status or coma. Continuously monitor cardiac rhythm.

Begin rehydrating the patient, and correct electrolyte and acid-base abnormalities. D5NS is the preferred IV fluid Start an IV, and infuse up to 1 L of 0.9% NS. If the patient is hypotensive, administer an NS bolus at 20 mL/kg. Check the patient’s glucose level and administer 25 to 50 g of D50 to correct the hypoglycemia.

Hydrocortisone, 100 mg IV, is indicated in the acute management of a crisis. Continuously reassess the vital signs and rapidly transport the patient.

Cushing syndrome

Cushing syndrome Caused by : Excess cortisol production by the adrenal glands. Excessive use of cortisol or other similar corticosteroid hormones.

Characteristic Changes Metabolism of carbohydrate, protein, and fat is disturbed. Blood glucose level rises. Protein synthesis is impaired so Body proteins are broken down which Leads to : loss of muscle fibers and muscle weakness Bones become weaker and more susceptible to fracture.

Clinical presentation Weakness and fatigue Increased thirst sensation and urination (hyperglycemia). Obesity and weight gain at : (a) Abdomen (b) Face (“moon face”) (c) Neck (d) Upper back (“buffalo hump”)

Clinical presentation Thinning of the skin leading to: (a) Easy bruising. (b) Pink or purple stretch marks (striae). Darkening of skin of the neck

Cushing Syndrome Clinical Manifestation

Management Patient with Cushing disease require long life treatment . Emergency treatment is focused on addressing ABCs.

Any questions? Home Work In a Table Compare Between : DKA and HHNK. Hypothyroidism and hyperthyroidism . Any questions?