Date post: | 01-Jan-2016 |
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Adrenal Anatomy
• Outer Cortex – aldosterone secretion
• Inner Cortex – cortisol and adrenal androgens
• Medulla - epinephrine
Gross Anatomy
• Pyramidal structure• 2-3 cm wide• 4-6 cm long• 1 cm thick• Usual wt 4 gm (up to 22 gm with chronic
illness and stress)• 3% of adults – macro-nodules• 65% of adults – microscopic nodules
Ectopic Adrenal Tissue
• Cortical Tissue• Retroperitoneal celiac plexus• Hilum of spleen• Ovaries• Scrotum• Liver• Wall of gallbladder• Cranium
Autoimmune Adrenalitis
• Humoral and cell-mediated
• Antibodies to 21-hydroxylase or other steroidogenic enzymes and all 3 zones of adrenal cortex
• Polyglandular – 70% females
• Isolated autoimmune – 71% males in first 2 decades, equal in 3rd decade and 81% female subsequently
Adrenal insufficiency
• First indication – increased plasma renin with nl or low serum aldo – zona glomerulosa
• Next – decreasing cortisol and elevated ACTH
Adrenal Insufficiency
• ½ have other autoimmune endocrine disorders
• Contrary is not as common
• <1% of Type 1 diabetics have adrenal insufficiency
PGA Type 2
• Much more common
• ½ of cases are familial
• Several modes of inheritance
• 2 times more frequent in women
Treatment of Adrenal Insufficiency
• Acute Treatment of Adrenal Crisis
• Chronic Therapy
• Treatment During Concurrent Illness