Sei sulla pagina 1di 27

Adrenal

disorders
Cortex Hipersekresi

Medulla
Hiposekresi
Disorders of adrenocortical
function
Adrenocortical hyperfunction
Glucocorticoids  Cushing’s syndrome
Aldosteronism  Conn’s disease

Adrenocortical hypofunction
Low Glucocorticoids Addison’s
Low Mineralocorticoids disease
Low Androgens
Adrenal Hyperfunction

Hyperaldosteronism
ACTH

Aldosterone

K Angiotensin II

Angiotensin I
EBV
Renin

Renin substrate

Major factors regulating aldosterone secretion; EBF(Effective Blood Volume)


Primary Hyperaldosteronism
• Accounts for about 0.7% of cases of hypertension
• Insidens : Women >>
• Etiology :
• Unilateral adrenocortical adenoma (Conn’s
syndrome - 73%)
• Bilateral (27%)
• Hyperaldosteronism :
– HYPERTENSION
– HYPOKALEMIA
– ALKALOSIS
Primary Hyperaldosteronism
Clinical finding : Hypertension, muscular
weakness, paresthesias, headache,
polydipsia, polyuria, moderate hypertension
(malignant is rare)

Laboratory finding : Serum potassium low,


24 hours urine collection aldosterone

Imaging : CT-scan
Primary Hyperaldosteronism

Treatment :
Laparoscopic adrenalectomy
Pharmaco : spironolactone and antihyper
tensive agent
Complication : Renal damage
Prognosis :
Improved by early diagnosis and treatment,
only 2% malignant
Secondary Hyperaldosteronism
• Defiition : an appropriately increased production of
aldosterone in response to activation of the renin-
angiotensin system

• production rate of aldosterone is often higher in patients


with secondary than in those with primary aldosteronism

• characterized by
- hypokalemic alkalosis,
- moderate to severe increases in plasma renin
- moderate to marked increases in aldosterone levels
Adrenal Insuffiency

Addison’s Disease
Disorders of adrenocortical insufficiency

Deficient adrenal production of glucocorticoid


and mineralocorticoid  Adrenocortical
insufficiency

@ Primary adrenocortical insufficiency


(Addison’s disease)
@ Secondary - deficient pituitary ACTH secretion,
glucocorticoid therapy (most common)
Addison’s Disease
• Addison's disease results from progressive destruction of the adrenals,
which must involve >90% of the glands before adrenal insufficiency
appears
• Etiology
Tbc (prior 1920)
Autoimmune adrenalitis  adrenal atrophy (80%)
Associated other immunologic and autoimmune endocrine disorders
AIDS
malignant disease
adrenal hemorrhage
adrenoleukodystrophy
Acute adrenal
withdrawl effect of corticosteroid insuffciency
• Incidence
Rare, female >>, 30-50 years
Clinical features

Cortisol deficiency  weakness, fatigue,


anorexia, nausea and vomiting, hypotension,
hyponatremia, and hypoglycemia.

Mineralocorticoid deficiency  renal sodium


wasting and potassium retention and can lead to
severe dehydration, hypotension, hyponatremia,
hyperkalemia, and acidosis.
Clinical features

Chronic primary adrenocortical insufficiency


Weakness, fatigue, anorexia, weight loss,
hyperpegmentasi, hypotension, gastrointestinal
disturbance

Acute adrenal crisis


Acute adrenal crisis represents a state of acute
adrenocortical insufficiency and occurs in patients with
Addison's disease who are exposed to the stress of
infection, trauma, surgery, or dehydration due to salt
deprivation, vomiting, or diarrhea  coma
Addison’s Disease  acute adrenal
insufficiency
Addison’s Disease
• Laboratorium :
Hiponatremia- hiperkalemia (classic)
Radiologis /CT Scan
• Diagnosis
Basal adrenokortical steroid Normal
Rapid ACTH stimulation test
ACTH plasma
• Treatment:
Replacement therapy  gluco and mineralocort
Regimen for maintenance therapy of primary
adrenocortical insufficiency (chronic
insufficiency)
1.Hydrocortisone, 15–20 mg in AM and 10 mg orally at 4–5
PM.
2.Fludrocortisone, 0.05–0.1 mg orally in AM.
3.Clinical follow-up: Maintenance of normal weight, blood
pressure, and electrolytes with regression of clinical
features.
4.Patient education plus identification card or bracelet.
5.Increased hydrocortisone dosage during “stress.”

Potrebbero piacerti anche