1. ADRENAL CORTEX CUSHING, CONN AND ADDISON DISEASE CUSHING, CONN AND ADDISON DISEASE Snježana Vukelić Mentor: A. Žmegač Horvat

2. Adrenal cortex

3. Hormones secreted by Hormones secreted by cortex CORTICOSTEROIDS GlucocorticoidsMineralocorticoids CORTISOLALDOSTERON immune system immune system glucose glucose stress stress blood pressure blood pressure water and salt balance water and salt balance

4. Cushing's syndrome

5. Pituitary adenomas Pituitary adenomas Ectopic ACTH sy Ectopic ACTH sy Adrenal tumors Adrenal tumors Familial Cushing’s Familial Cushing’s Drug related Drug related 24-hour urinary free cortisol level Cushing’s disease

6. Cushing's syndrome TREATMENT SURGERY SURGERY RADIATION RADIATION CHEMOTHERAPY CHEMOTHERAPY CORTISOL-INHIBITING DRUGS CORTISOL-INHIBITING DRUGS

7. Conn's Conn's syndrome HYPERTENSION TIREDNESS TIREDNESS MUSCLE WEAKNESS MUSCLE WEAKNESS POLYURIA POLYURIA ↓ BLOOD POTASSIUM ADRENAL ADENOMA

8. Conn's syndrome TREATMENT SURGICAL REMOVAL SURGICAL REMOVAL (UNILATERAL ADRENALECTOMY) (UNILATERAL ADRENALECTOMY) SPIRINOLACTONE SPIRINOLACTONE

9. Addison’s disease WEIGHT LOSS WEIGHT LOSS MUSCLE WEAKNESS MUSCLE WEAKNESS FATIGUE FATIGUE LOW BLOOD PRESSURE LOW BLOOD PRESSURE DARKENING OF SKIN DARKENING OF SKIN

10. Addison’s disease PRIMARYPRIMARY destruction of adrenal cortexdestruction of adrenal cortex - autoimmune disorders - autoimmune disorders - tuberculosis - tuberculosis - chronic infection - chronic infection SECONDARY Lack of ACTH - drugs - tumors and infections of pituitary gland CORTISOLALDOSTERONE CORTISOL

11. Addison’s disease DIAGNOSIS ACTH STIMULATION TEST TREATMENT REPLACEMENT THERAPY CORTISOLHYDROCORTISONE ALDOSTERONEFLUDROCORTISONE

12. Addison’s disease ADDISONIAN CRISIS ACUTE ADRENAL INSUFFICIENCY - SUDDEN PENETRATING PAIN IN LOWER BACK, ABDOMEN OR LEGS - SEVERE VOMITING AND DIARRHEA, FOLLOWED BY DEHYDRATION - LOW BLOOD PRESSURE - LOSS OF CONSCIOUSNESS - HYDROCORTISONE i.v. - 0,9 % NaCl i.v. - DEXTROSE

13. Literature http://en.wikipedia.org/wiki/Adrenal_gland#A drenal_cortexhttp://en.wikipedia.org/wiki/Adrenal_gland#A drenal_cortex http://users.rcn.com/jkimball.ma.ultranet/Biol ogyPages/A/Adrenals.htmlhttp://users.rcn.com/jkimball.ma.ultranet/Biol ogyPages/A/Adrenals.html http://www.endocrineweb.com/adrenal.html