Date post: | 14-Feb-2017 |
Category: |
Health & Medicine |
Upload: | surgerymgmcri |
View: | 54 times |
Download: | 0 times |
ADRENAL AND OTHER ENDOCRINE SYSTEM
A OVERVIEW
Dr Saravanakumar
Major endocrine systems in the body
Thyroid gland Parathyroid , calcitonin Pancreas Adrenal gland Pituitary gland The gonads Others Kidney , heart , pineal gland
Adrenal gland - Anatomy
Function
Adrenal medulla - secretes adrenalin , nor adrenalin , dopamine
Adrenal cortex - steroid hormones 1. mineralocorticoids- aldosterone 2. glucocorticoids –cortisol , corticosterone3. sex hormones – DHEA ,androstenedione
Incidentaloma Definition Incidentaloma is an adrenal mass,
detected incidentally by imaging studies conducted for other reasons.
Prevalence -incidentalomas
Imaging study – CT and MRI
TREATMENT
Hypertension , hypokalemia , suppressed reninactivity , female predominanceLAB tests and imaging aid the diagnosis
TREATMENT Spironolatone,Anti Hypertensive'ssurgery
Cushing's syndrome ACTH Dependent
1) Pituitary adenoma – Cushing's disease 2) ACTH Secreting tumours – small cell lung
Ca,foregut carcinoid ,pancreatic Neuroendocrine tumours , medullary Ca thyroid
ACTH independent – adrenal tumours
Treatment Medical therapy
with metyrapone or ketoconazole
trans-sphenoidal resection or radiotherapy
Adrenalectomy- unilateral or bilateral
Adrenal carcinoma Primary – very rare Bimodal age
distribution, female predominance
Poor prognosis Difficulty in diagnosis 60 % Cushing's synd. Surgery followed by
chemo and radiotherapy
Secondary breast, lung, renal,
gastric, pancreatic, ovarian and colorectal cancer
Treat the primary
Disorders of adrenal medulla
Pheochromocytoma Paraganglioma
Pheochromocytoma Pheochromocytoma is known as the ’10 per
cent tumour’ as 10 per cent of tumours are inherited, 10 per cent are extra-adrenal, 10 per cent are malignant, 10 per cent are bilateral and 10 per cent occur in children
Hereditary Pheochromocytoma -Multiple endocrine neoplasia type 2 (MEN 2),Familial paraganglioma (PG) syndrome, von Hippel–Lindau (VHL) syndrome, Neurofibromatosis (NF) type 1
SWISS CHEESE CONFIGURATION
IN CT123I-MIBG
(metaiodobenzylguanidine)
single-photon emission computed tomography
(SPECT)
MANAGEMENT
To start with α-blocker (phenoxy benzamine)
Add β blocker if necessary Plan for surgery Yearly lifelong follow up
Other tumours 1) Neuroblastoma 2) Ganglioneuroma