Adrenal disorders

Steroid actions l Amino acid catabolism (muscle wasting)… gluconeogenesis in the liver.. Hyperglycemia… increased insulin output… eventual beta cell failure… fat deposition… diabetes l Ca resorption, impairment of Ca absorbtion, increased renal Ca excretion…. osteoporosis l Increased gastric acidity… ulcer formation or aggravation l K loss and Na retention… edema and hypertension l Initially increased antibody release.. Eventually decreased antibody production, lymphocytopenia, eosinopenia, neutrophelia, polycythemia… susceptibility to infections l Maintenance of arteriolar tone and blood pressure

Cushing’s Syndrome

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

Frequency of signs and symptoms in Cushing’s syndrome Sign or symptom Occurrence % Sign or symptom Occurrence % Central obesity94Easy bruisability60 Hypertension82Osteoporosis60 Glucose intolerance80Personality changes 55 Hirsutism75Acne50 Amenorrhea or impotency75Edema50 Purple striae65Headache40 Plethoric faces60Poor wound healing40

Pre treatment Post treatment

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Adrenal Insufficiency

Causes of Adrenal Insufficiency l Primary n Idiopathic (Addison disease) n Tuberculosis n Fungal infections n Adrenal hemorrhage n Congenital adrenal hypoplasia n Sarcoidosis n Amyloidosis n Metastatic neoplasia n Others

Causes of Adrenal Insufficiency l Secondary n After exogenous glucocorticoids n After the cure of Cushing syndrome (removing endogenous glucocorticoids) n Hypothalamic and pituitary lesions

Major Clinical Features in Adrenal Insufficiency l Weakness l Skin n 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 l Loss of weight, emaciation, anorexia, vomiting, diarrhea l Hypotension l Salt craving l Hypoglycemic episodes

Congenital adrenal hyperplasia

Hyperaldosteronism

Renin Angiotensin System Angiotensinogen Angiotensin I Angiotensin II Angiotensin III aldosterone Renin Converting enzyme (-)

Signs and labs of hyperaldosteronism l Hypertension l Hypokalemia l Urine potassium wasting l Increased aldosterone l Low renin

Pheochromocytoma

Clinical manifestations l Intermittent hypertension or even hypotension l headache 71%, palpitations 65%, sweating 65% and dizziness 15%, sense of doom l Vomiting 28%, weakness 17%, nervousness 10%, pallor 16%, dyspnea 19%, substernal pain 12%, and abdominal pain 12% l Glycosuria l neutrophelia

The End