Adrenal disease

Iswandi Darwis

Departemen Ilmu Penyakit Dalam

Fakultas Kedokteran Universitas Lampung
Rumah Sakit Umum Daerah Hi. Abdul Moeloek
Bandar Lampung
Hypophysis-Adrenal Axis
Adrenal gland hormone
 Function of adrenal hormone
• Mineralocorticoids: the most important of which is aldosterone. This hormone
helps to maintain the body’s salt and water levels which, in turn, regulates
blood pressure. Without aldosterone, the kidney loses excessive amounts of
salt (sodium) and, consequently, water, leading to severe dehydration and low
blood pressure.
• Glucocorticoids: predominantly cortisol. This hormone is involved in the
response to illness and also helps to regulate body metabolism. Cortisol
stimulates glucose production helping the body to free up the necessary
ingredients from storage (fat and muscle) to make glucose. Cortisol also has
significant anti-inflammatory effects.
• Adrenal androgens: male sex hormones mainly dehydroepiandrosterone
(DHEA) and testosterone. All have weak effects, but play a role in early
development of the male sex organs in childhood, and female body hair during
puberty.
 Adrenal Gland Hypofunction
• Adrenocortical steroids may decrease as a
result of inadequate secretion of ACTH
• Dysfunction of the hypothalamic-pituitary
control mechanism
• Direct dysfunction of adrenal tissue
 Effect of Insufficiency of
Adrenocortical Steroids
• Loss of aldosterone and cortical action
• Decreased gluconeogenesis
• Depletion of liver and muscle glycogen
• Hypoglycemia
• Reduced urea nitrogen excretion
• Anorexia and weight loss
• Potassium, sodium, and water imbalances
 Addison’s Disease
• Primary
• Secondary:
– Sudden cessation of long-term high-dose
glucocorticoid therapy
 Acute Adrenal
Insufficiency/Addisonian Crisis
• Life-threatening event in which the need for
cortisol and aldosterone is greater than the
available supply
• Usually occurs in a response to a stressful
event
 Patient-Centered Collaborative Care
• Assessment
• Clinical manifestations
 Assessment
• Psychosocial assessment
• Laboratory tests
• Imaging assessment
 Adrenal Gland Hyperfunction
• Hypersecretion by the adrenal cortex results
in Cushing’s syndrome/disease,
hypercortisolism, or excessive androgen
production
 Pheochromocytoma
• Hyperstimulation of the adrenal medulla
caused by a tumor
• Excessive secretion of catecholamines
 Hypercortisolism (Cushing’s Disease)
• Etiology
• Incidence/prevalence
• Patient-centered collaborative care
• Assessment:
– Clinical manifestations—skin changes, cardiac
changes, musculoskeletal changes, glucose
metabolism, immune changes
 Hypercortisolism
Cushing’s Disease
– Psychosocial assessment
– Laboratory tests—blood, salivary and urine
cortisol levels
– Imaging assessment
 Hypercortisolism: Nonsurgical
Management
• Patient safety
• Drug therapy
• Nutrition therapy
• Monitoring
 Hypercortisolism: Surgical
Management
• Hypophysectomy
• Adrenalectomy
 Community-Based Care
• Home care management
• Health teaching
• Health care resources
 Hyperaldosteronism
• Increased secretion of aldosterone results in
mineralocorticoid excess.
• Primary hyperaldosteronism (Conn's
syndrome) is a result of excessive secretion of
aldosterone from one or both adrenal glands.
 Patient-Centered Collaborative Care
• Assessment
• Most common issues—hypokalemia and
elevated blood pressure
 Interventions
• Adrenalectomy
• Drug therapy
• Glucocorticoid replacement
• When surgery cannot be performed—
spironolactone therapy
 Pheochromocytoma
• Catecholamine-producing tumors that arise in
the adrenal medulla
• Tumors produce, store, and release
epinephrine and norepinephrine
Thanks you