1. Dr. Amel Eassawi

2. At the end of this lecture the student should be able to:  Describe Pathophysiology of hypo and hyperpadrenalism.  Correlate the features of hypo and hyper adrenalism with the physiological action and control mechanism of adrenocortical hormones.  Describe the different stress mechanisms and the body’s response to these stressors.

3. Adrenocortical hormones Hyper secretion AldosteroneConn’s Sec.Hyper Aldosteronism Cortisol Cushing’s syndrome DHEA Adrenogenital Syndrome Hyposecretion Addison’s Disease 3

4. Primary hyperaldosteronism, or Conn’s syndrome)- Adrenal tumor. Secondary hyperaldosteronism- inappropriately high activity of the renin-angiotensin-aldosterone system. Cortisol hypersecretion - (Cushing’s syndrome). Adrenal androgen hypersecretion – adrenogenital syndrome. 4

5. Primary hyperaldosteronism, or Conn’s syndrome – Cause: Adrenal tumor of aldosterone –secreting cells Secondary hyperaldosteronism – Cause: inappropriately high activity of the renin-angiotensin-aldosterone system. Symptoms: excessive Na + retention (hypernatremia) and K + depletion (hypokalemia). high blood pressure (hypertension) 5

6. Cause – Overstimulation of the adrenal cortex by excessive amounts of CRH and/or ACTH, – Adrenal tumors that uncontrollably secrete cortisol independent of ACTH, – ACTH-secreting tumors located in places other than the pituitary, most commonly in the lung 6

7. Features – High blood glucose – Glucosuria – Adrenal diabetes – Protein shortage – Buffalo hump – Moon face – Thin extremities, weakness & fatigue – Reddish – purple linear stria 7

8. 8

9. 9 AfterBefore

10. 10

11. Adrenogenital syndrome In adult females – Male pattern of body hair – Deep voice – Muscular arms & leg – Decrease breast size, menstrual suppression 11

12. Adrenogenital syndrome In newborn females – Male type of external genitalia – female pseudohermaphroditism In pubertal males – prematurely develop male secondary sexual characteristics – precocious pseudopuberty In adult males – No apparent effect 12

13. Hormonal interrelationships in adrenogenital syndrome 13

14. Primary adrenocortical insufficiency, also known as Addison’s disease – Autoimmune destruction of cortex Features are related to Aldosterone deficiency – K + retention (hyperkalemia), – Na + depletion (hyponatremia), – disturbed cardiac rhythm. – Hypotension Features are related to cortisol deficiency – poor response to stress, – hypoglycemia (low blood glucose) – hyperpigmentation (darkening of the skin) 14

15.  Human physiology, Lauralee Sherwood, seventh edition.  Text book physiology by Guyton &Hall,11 th edition.  Text book of physiology by Linda.S.Costanzo third edition 15