1. DISEASES OF THE ENDOCRINE SYSTEM SUPRARENAL GLAND
DR HEYAM AWAD
FRCPATH

2. SUPRARENAL GLAND
ADRENAL GLAND…. CORTEX, AND MEDULLA

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

5. HYPERADRENALISM CUSHING SYNDROME HYPERALDOSTERONISM
VIRILISING SYNDROMES

6. 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

7. 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

8. ADRENOCORTICAL CAUSES
ACTH INDEPENDENT
HYPERPLASIA, ADENOMA OR CARCINOMA

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

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

11. 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

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

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

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

15. CLINICAL FEATURS
HYPERENTION
HYPOKALEMIA

16. ADRENOGENITLA SYNDROMES
CONGENITAL ADRENOCORTICAL HYPERPLASIA… AUTOSOMAL RECESSIVE
ADRENOCORTICAL NEOPLASMS

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

18. 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

19. 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..

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

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

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

23. PHEOCHROMOCYTPMA ORIGINATE FROM CHROMAFFIN CELLS
CORRECTABLE FORM OF HYPERTENTION
SECRTEVCATECHOLAMINES

24. 10% RULE
FAMILIAL
BILATERAL
MALIGNANT
EXTRAADRENAL… PARAGANGLIOMAS

25. CLINICAL PICTURE HYPERTENTION PALPITATION SWEATING TREMOR
HEART FAILURE