1. ADRENAL GLAND DISORDERS
Dr. Hany Ahmed
Assistant Professor of Physiology (MD, PhD).
Al Maarefa Colleges (KSA) & Zagazig University (ARE)
Specialist of Diabetes, Metabolism and Obesity
Zagazig Obesity Management & Research Unit

2. Lecture Objectives
At the end of this lecture, the student should be able to:
Describe pheochromocytoma
Enumerate the disorders of adrenocortical function
Describe the Pathophysiology of hypofunction of adrenal cortex
Describe the Pathophysiology of hyperfunction of adrenal cortex

3. Tumor of suprarenal medulla (PHEOCHROMOCYTOMA)
Excessive catecholamines secretion.
Patient develops persistent or paroxysmal attacks of hypertension, hyperglycemia and  metabolic rate.
The attacks are precipitated by emotion, exercise or meal.
The attack consists of severe headache, sweating, pallor, pain in chest, vomiting and dilatation of pupil.
Treated during attack by combined α-blocker & β-blocker.
Then, surgical removal is done after attack.

4. DISORDERS OF ADRENOCORTICAL FUNCTION

5. Adrenocortical hormones
Hypersecretion
Aldosterone
Conn’s
syndrome
2ry Hyper
Aldosteronism
Cortisol
Cushing’s
DHEA
Adrenogenital
Syndrome
Hyposecretion
Addison’s
Disease
Pathophysiology

6. 1- CHRONIC ADRENAL INSUFFICIENCY (=ADDISON’S DISEASE )
Chronic insufficiency of both cortisol and aldosterone
Causes: Atrophy or destruction of gland by TB & Autoimmune adrenalitis.
Clinical picture:
Hyperpigmentation of skin: In exposed areas, points of friction and pressure, scar and areolae. Due to ↑ melanin pigment as a result of ↑ ACTH as a feedback mechanism (due to  cortisol).
Hypotension & Postural Hypotension: due to volume depletion (Na+ & fluid depletion).

7. ADDISON’S DISEASE 3) Hyponatremia & hypotension.
4) Hyperkalaemia & Hypoglycemia  Muscular weakness.
5) Vomiting & dehydration.
6) Dehydration  hypotension   renal blood flow & GFR  Oliguria  urea retention.
7) ↓ Capacity to withstand stresses e.g. hemorrhage
Treatment: Replacement therapy

8. ADDISON’S DISEASE Features related to Aldosterone deficiency
Hyperkalemia
Hyponatremia
Disturbed cardiac rhythm
Hypotension
Features related to cortisol deficiency
Poor response to stress
Hypoglycemia
Hyperpigmentation of the skin

9. 2- ACUTE ADRENAL INSUFFICIENCY (= ADRENAL CRISIS)
Causes:
Exposure to a sudden stress (infection or operation) in patients with adrenals secreting basal amount of cortisol only.
Direct damage of adrenal cortex by meningococcal septicemia.

10. ADRENAL CRISIS Clinical picture: Hyponatremia & hypotension.
Hyperkalaemia & Hypoglycemia  Muscular weakness.
Vomiting & dehydration.
Oliguria  urea retention.
Shock & death
Treatment:
IV fluids & cortisone.

11. HYPERALDOSTERONISM Primary hyperaldosteronism (Conn’s syndrome):
Cause:
Adrenal tumor of aldosterone – secreting cells
Secondary hyperaldosteronism:
Inappropriately high activity of renin-angiotensin-aldosterone system

12. CUSHING’S SYNDROME Prolonged excessive production of Cortisol due to:
Causes:
1- Adrenal tumor (Cushing ,s syndrome)    Cortisol.
2- Pituitary adenoma (Cushing ,s disease)    ACTH  adrenal hyperplasia.
Clinical picture:
Wasting & weakness of skeletal muscles due to:
Protein breakdown of muscle.
2) Abnormal distribution of fat:
Face becomes rounded (= moon-face).
Fat deposition in supraclavicular region and on back of neck (buffalo-neck).
3) Hyperglycemia & glucosuria (=Adrenal diabetes).

13. CUSHING’S SYNDROME
Pendulous abdomen with Purplish striae (due to stretching of skin and tearing of weak subcutaneous tissues).
Skin is thin with easy bruising, acne and excess body and facial hair.
Osteoporosis due to loss of protein matrix & demineralization of bones.
Polycythaemia &  lymphocytes and eosinophils.
Retention of Na+ & fluids  oedema & hypertension.
Hypokalaemia.

14. C CENTRAL OBESITY, CERVICAL FAT PADS, COLLAGEN FIBER WEAKNESS
U URINARY FREE CORTISOL & GLUCOSE INCREASE
S STRIAE & SUPPRESSED IMMUNITY
H HYPERGLYCEMIA, HYPERTENSION & HIRSUTISM
I INCREASED PLASMA CORTISOL & GLUCOSE LEVEL.
N NEOPLASMS (ADRENAL OR PITUITARY TUMOUR)
G GONADAL AFFECTION (AMENORRHEA) & GROWTH RETARDATION

16. ADRENOGENITAL SYNDROME
Excessive production of sex hormones (mainly male sex hormones).
Male
Female
Before
Birth
Enlarged external genitalia
(Macro-genitosomia precox)
Enlarged clitoris & labia resembling that
of male external genitalia
(♀ Pseudo-hermaphroditism) In
Childhood
Premature sexual development
Enlarged penis.
Appearance of pubic hair.
Short (early union of epiphysis)
(Precocious Pseudopuberty) i.e.Precocious development of 2ry Sex characters Without testicular growth.
No development of ♀ sexual characters.
No enlargement of breast
Deepening of voice.
Muscular growth.
Adulthood
-  Muscular power
-  Sexual desire.
Virilism
Hirsutism = Male hair distribution.
Frontal balding & Deepening of voice.
Amenorrhea.
Atrophy of uterus & breast.
Clitoris Hypertrophy & Homosexuality.

17. Hormonal interrelationships in adrenogenital syndrome

18. Endocrine response to stress

22. References Human physiology, Lauralee Sherwood, seventh edition.
Text book physiology by Guyton &Hall,11th edition.
Text book of physiology by Linda .S .Costanzo third edition