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DR M ABDUR RAHIM

M.D.,

ASST PROFESSOR OFMEDICINE

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ADRENAL GLANDS

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INTRODUCTION

Several separate endocrine glands within a

single Anatomical structure

Adrenal Medula- Extension of the

sympathetic Nervous System which

secretes Catecholamines into capillaries

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Adrenal Cortex – Secrete cortisol, Adrenal

androgens and part of HPA axis.

Small outer Glomerulosa of cortex

secretes Aldosterone under the control of RAS

Integrated control of CVS, metabolic andImmune responses to stress

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Subtle alterations in adrenal function

contributes to Hypertension, Obesity and

Type II DM

Classical syndrome of adrenal hormone

excess and deficiency are rare

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ANATOMY

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PHYSIOLOGY

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FUNCTIONS

Glucocorticoids :- CortisolHighest in Morning

Lowest in Midnight

Rises during Stress95% Cortisol binds Globulin

Free fraction only is active

Binds Glucocorticoid receptors to

regulate transcription of many genes

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Mineralocorticoids: Aldosterone

Binds to receptors in Kidney and

causes Sodium retention, increased

excretion of Potassium and Protons

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Catecholamines : Norepinephrine

Converted to Epinephrine by

enzyme COMT induced by

Glucocorticoids.

Blood flow in Adrenaline is

Centripetal.

No consequences of insufficiency

even after surgical removal of 

Adrenal Medullae.

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Adrenal Androgens

Abundant in blood stream

Important in intiation of Puberty &

Female Libido

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ADRENAL DISEASES

Hormone Excess

Cushing’s Syndrome

Primary HyperAldosteronism

Phaeochromocytoma

Hormone DeficiencyAddison’s Disease

Congenital Adrenal Hyperplasia

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CUSHING’S SYNDROME 

Caused by Excessive activation of Glucocorticoid receptors

Iatrogenic – Common

EQUIVALENT DOSES OF GLUCOCORTICOIDS

- Dexamethasone 0.5mg

- Prednisolone 5mg

- Hydrocortisone 20mg

- Cortisone Acetate 25mg 

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ETIOLOGY

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  Cushing’s Disease – 80%

4 times more common in Women.

Ectopic ACTH common in Men.

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Clinical Features

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Investigations

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Management

Medical management : InhibitCorticosteriod biosynthesis

- Metyrapone & Ketaconazole

Surgical management :

Cushing’s Disease – Trans-sphenoidal

Surgery- Alternatively

Bilateral Adrenalectomy

(Nelson’s Syndrome) 

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Adrenal Tumours – Laparoscopic / Loin

Incision removal of Adenomas

Ectopic ACTH Syndrome -

Surgical removal of Localized

Tumour

Incurable Malignancy-Medical Therapy / 

Bilateral Adrenalactomy

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PRIMARY HYPERALDOSTERONISM

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CLINCAL FEATURES

Usually Asymptomatic Features of Sodium retention

- Oedema

Features of Potassium loss- Muscle weakness

Polyuria

Tetany

Hypertension

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INVESTIGATIONS

Serum Electrolytes

Imaging – CT or MRI – indentify APAs

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MANAGEMENT

Spironolactone Eplerenone

Amiloride

Laparoscopic Surgery

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Phaeochromocytoma

Rare Neuro-endocrine Tumours

80% occur in Adrenal Medula

20% in Sympathetic Ganglia

Associated with Inherited disorders

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INVESTIGATIONS

Plasma / Urine Metanephrine andNormetanephrine

Serum Chromogrenin A

CT or MRI

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MANAGEMENT

Medical Therapy before Surgery

Minimum 6 weeks

Alpha Blocker Phenoxybenzamine

(10-20mg, 6 – 8 hrly)

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ADRENAL INSUFFICIENCY

Inadequate secretion of Cortisol and or

Aldosterone

Variable in presentation & Fatal

High index of suspicion

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ETIOLOGY

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CLINICAL FEATURES

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INVESTIAGATION

Assessment of Glucocorticoids

Mineralocorticoids

Adrenal Androgens

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