MLAB 2401: Clinical Chemistry

Keri Brophy-Martinez
Disorders of the Adrenal Gland
 Addison’s Disease
• What is it?
– Atrophy or destruction of adrenal cortex
(PRIMARY)
• Idiopathic
• Autoimmune adrenalitis
• Tuberculosis

– Adrenal insufficiency (SECONDARY)

• Hypothalamic/pituitary disease
 Clinical Features: Addison’s
Disease
Laboratory Manifestations
• Decreased cortisol levels • Increased skin pigmentation
– Both serum & urine • Tiredness
• Decreased aldosterone • Intestinal issues
• Increased ACTH • Hypotension
– > 200 pg/mL • Hypoglycemia
• Hyperkalemia
• Hyponatremia/hypocholoremia
• Loss of body hair
• Depression
 Addison’s Disease
Increased MSH

Increased
pigment of skin
Increased
No ACTH
inhibition
of ACTH
Shrunken Adrenal
Cortex

Low Low
cortisol Aldosterone
 Cushing’s Syndrome
• Caused by:
– Excess glucocorticoid production
• Cortisol-secreting adrenal carcinoma or adenoma
– Prolonged exogenous steroid use
• iatrogenic
 Laboratory Features
• Increased serum
cortisol
– Lack of diurnal variation
of cortisol
• Hyperglycemia

Sunheimer, R., & Graves, L. (2010). Clinical Laboratory Chemistry.

Upper Saddle River: Pearson
 Cushing’s Syndrome
• Manifestations
– Weight gain in face and
abdomen
– Buffalo hump back
– Muscle
wasting/weakness
– Easy bruising
– Hypertension
– Osteoporosis
– Hyperglycemia
 Conn’s Syndrome
• Caused by:
– Aldosterone-secreting adrenal adenoma of
adrenal cortex (Primary)
– Disorders within the renin-angiotensin system
(Secondary)
Clinical Features: Conn’s Syndrome
Laboratory Manifestations
• Low serum potassium • Muscle weakness
• High serum sodium • Increased urination
• High aldosterone levels • Hypertension
• Acid/base imbalances
 Adrenal Medulla Disorders
• Pheochromocytoma
– Benign or malignant tumors in the adrenal
medulla
– Causes hypertension
• Neuroblastoma/Ganlioneuromas
– Common malignant tumors in pediatric patients
Disorders of Sexual Development
 Testosterone
• Hyperandrogenemia
– Increased testosterone production
• In females: hirsutism ( see next slide)
– Due to tumors in hypothalamus, testicles, or
congenital adrenal hyperplasia
• Hypoandrogenemia
– Decreased testosterone production
– Due to infections, tumors, congenital disorders, or
decreased function of pituitary/ hypothalamus
 Hirsutism
• Abnormal, abundant,
hair growth( lip, chin,
side burn, neck)
• Loss of female sex
characteristics
• Ethnic origin important
– Italians, eastern
europeans, eastern
Indian, Irish
 hCG & Human placental lactogen
• hCG
– Increased
• Hydatidiform mole, choriocarcinoma, pre-eclamptic
toxemia
– Decreased
• Threatened abortion, ectopic pregnancy
• Human placental lactogen
– Normal to rise throughout gestation
– Decreased levels suggest placental malfunction or fetal
distress
 Estrogen
• Hyperestrinism
– Overproduction of estrogen
– Females
• Early puberty
• Infertility & irregular menses
• Postmenopausal bleeding
– Males
• Testicular atrophy
• Breast enlargement
 Estrogen
• Hypoestrinism
– Decreased production of estrogen
• Ovarian insufficiency
• Delayed puberty
• Amenorrhea
• Turner Syndrome
 Progesterone
• Hyperprogesteronemia
– Prevents menstrual cycle

• Hypoprogesteronemia
– Results in infertility
– Abortion of fetus
 Menstrual Cycle Abnormalities
• Average cycle is 28 days
• Menopause between 45-55 years

• Amenorrhea
– Absence of menses
– Primary: never menstruated
– Secondary: Had at least one menstrual cycle
• Oligomenorrhea
– Irregular menses
– Cycle length in excess of 35- 40 days
• Menorrhagia
– Uterine bleeding > 7 days
 References
• Bishop, M., Fody, E., & Schoeff, l. (2010).
Clinical Chemistry: Techniques, principles,
Correlations. Baltimore: Wolters Kluwer
Lippincott Williams & Wilkins.
• Sunheimer, R., & Graves, L. (2010). Clinical
Laboratory Chemistry. Upper Saddle River:
Pearson .

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