1. Adrenal disorders

5. 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

6. Cushing’s Syndrome

8. 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

9. 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

16. Pre treatment Post treatment

17. Old picture

21. Adrenal Insufficiency

22. 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

23. 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

25. 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

37. Congenital adrenal hyperplasia

39. Hyperaldosteronism

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

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

44. Pheochromocytoma

45. 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

46. The End