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Disorders
Dr Jawwad Anis Khan
MBBS,MCPS,FCPS
Adrenal Gland
Two in number
Weighs 3-5 gms each
Rich blood supply
Adrenal consists of outer cortex.
1.
2.
3.
Zona Glomerulosa :
(Mineralocorticoid)
Zona Fasiculata :
(Glucocorticoid)
Zona Reticularis :
Aldosterone
Cortisol
DHEA (Androgen)
Adrenal gland
Adrenal gland
Sodium reabsorption
K+ excretion
H+ excretion
Water reabsorption Increase ECF volume
Increase blood volume & maintain blood
pressure
Adrenal Disorders
Disorders of adrenal Cortex:
Adrenal hypofunction Addisons
disease
Adrenal hyperfunction :
Pheochromocytoma
Addisons Disease
(Primary Adrenal
Insufficiency)
Addisons Disease
(contd..)
Etiology:
Autoimmune
Tuberculosis
Glucocorticoid treatment
Surgical bilateral adrenalectomy
Secondary tumour deposits
Fungal disorders Histoplasmosis
Haemochromatosis, Amyloidosis,
Sarcoidosis,
Addisons Disease
(contd..)
Etiology (Contd):
Adrenal haemorrhage : septicaemia,
anticoagulant therapy, waterhouse
Friderichsen syndrome, bleeding disorders.
Radiation therapy.
Clinical Features
Laboratory
Investigations
Laboratory Investigations
(Contd..)
Hyperkalaemia, hyponatraemia.
Increased urea
Hypoglycaemia
Mild anaemia, Neutropenia,
Eosinophilia.
Anti adrenal antibodies.
Radiological
Investigations
Chest X-ray
R/O Tuberculosis
Abdomen X-ray
R/O
Tuberculosis
Ultrasound abdomen
CT abdomen
Cushings Syndrome
(Hypercortisolism)
Cushings Syndrome
(Hypercortisolism)
Etiology:
Clinical Features of
Cushings Syndrome
Effects of Glucocorticoid Excess
Clinical Features of
Cushings Syndrome
(Contd..)
Hyperpigmentation
Hypertension
Hypokalaemia
Clinical Features of
Cushings Syndrome
(Contd..)
Headache
Visual field defects
Hypopituitarism
Laboratory
Investigations
Diagnostic approach:
Adrenal source
Pituitary pathology ( Cushing disease)
Ectopic ACTH producing tumors.
Laboratory
Investigations
To establish the diagnosis of
hypercortisolism:
Plasma cortisol:
In normal individuals:
10 28 ug/dl
5 10 ug/dl
In Cushing syndrome:
Laboratory Investigations
(Contd..)
Overnight Dexamethasone Suppression
Test:
Best Screening Test.
2mg oral dexamethasone given at 2300 Hrs.
Blood specimen for plasma cortisol-next
morning at 0800Hrs
Normal individuals: Plasma Cortisol
Suppressed to < 50% of basal level.
Cushing Syndrome: Failure to suppression
of plasma cortisol levels
Laboratory Investigations
(Contd..)
Laboratory Investigations
(Contd..)
To find out the cause of
hypercortisolism:
Plasma ACTH:
High plasma ACTH
Pituitary Adenoma. (Cushings disease)
Ectopic ACTH secretion by tumors.
Low plasma ACTH
Adrenal tumors
Other Laboratory
investigations
Radiological
Investigation
For localization of tumors
MRI pituitary.
CT Scan chest, abdomen.
CT Scan Adrenals.
Congenital Adrenal
Hyperplasia - CAH
1.
2.
3.
Congenital Adrenal
Hyperplasia - CAH
Pheochromocytoma
Pheochromocytoma
SUMMARY
SUMMARY
SUMMARY
Interactive Session
QUESTIONS
QUESTIONS
QUESTIONS
QUESTIONS
QUESTIONS
QUESTIONS
QUESTIONS
THANK YOU