Adrenal disorders. Steroid actions l Amino acid catabolism (muscle wasting)… gluconeogenesis in...
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Transcript of Adrenal disorders. Steroid actions l Amino acid catabolism (muscle wasting)… gluconeogenesis in...
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