Kelenjar Adrenal danpermasalahannyadr. Nur Anna C Sadyah SpPD FINASIM

The EndocrineSystem

Adrenal Cortex (outer region)• The adrenal cortex

secretes 3 steroids:• 1. Glucocorticoids• 2. Mineralocorticoids• 3. Sex Hormones

Glucocorticoid

• Decreases inflammation response• Decreases stress of:• TB• Pneumonia• Arthritis• Asthma• allergies

Glucocorticoid• Slows the healing process,

decreases resistance tosome diseases

• They assist to ensure asteady supply of glucosefor the brain and othercells.

• The primary glucorticoid iscortisol also calledhydrocortisone (stresshormone)

Glucocorticoid

• Indication for the release of this hormone.• 1. Disease• 2. Physical injury• 3. Hemorrhage• 4. Infection• 5. Pregnancy• 6. Extreme temperature• 7. Emotional stress (rage and anger)

Adrenal Cortex (outer region)

• Hyposecretion - cortex degeneration– Addison's disease (adrenal insufficiency)

• A. generalize weakness• B. muscle atrophy• C. severe fluid loss• D. bronzing of the skin• E. Must be tx with steroids & fluids

Adrenal Cortex (outer region)– Hypoglycemia and

decreased blood pressure– Decreased Na+ and

increased K+ problems– Unusual skin pigmentation

(patches of color)

Adrenal Cortex

• Hypersecretion of glucocorticoids– Cushing's syndrome– Obesity– Buffalo hump - fat deposited across the

shoulders– Moon faced - often flushed– Abdominal striations - stretch marks– Heavy abdomen and skinny legs– Thin skin that bruises easily

Hypersecretion ofglucocorticoids• The price of enhanced

athletic performance ishigh. Severe andirreversible healthproblems, such as:

• A. cancer• B. osteoporosis (bone

softening)• C. mental illness• All are complication of

hypersecretion.

Adrenal Cortex

• Hypersecretion of gonadocorticoids– Adrenogenital syndrome– Female baby:

• Development of pubic hair• Enlarged clitoris• Enlarged labia majora• Sex can be confused as a male

Adrenal Cortex– Males:

• Premature development• Enlarged penis• Early sex drive• Excess body hair

Adrenal Cortex– Females

• Masculinization and prematuredevelopment

• Facial and body hair growth(masculine)

• Deeper voice and recedinghairline

• Decrease in breast size andincrease in clitoris size

Mineralocorticoids

• The chief mineralocorticoid is aldosterone.

• It’s role is regulation of:• A. blood volume• B. blood pressure

Mineralocorticoids• The primary targeted

organ is the kidney

• Aldosterone conservessodium and water andeliminates potassium.

Sex Hormones (Gonadocorticoids)

• Not secreted until puberty• Production stimulated by

the gonad hormones• Of the gonad hormones,

testosterone is dominant• Normally production is

small

Sex Hormones(Gonadocorticoids)• When secreted the female

hormone is calledestrogens.

• When secreted the malehormone is calledandrogens

Adrenal Medulla• Secretes 2 hormones• 1. Epinephrine (adrenalin)• 2. Norepinephrine

• These 2 hormones are alsoknown as catecholamines.These hormones aresecreted in stress situations

Adrenal Medulla– Classified as Amine type

hormones, 80% of secretion isepinephrine

– Production stimulated bystress

– Related to the sympathetichalf of the autonomicnervous system

Epinephrine (Adrenalin) andNorepinephrine• Functions

– Increases blood pressure,heart output and respiratoryrate

– Increases blood sugar; How?Converting glycogen toglucose in the liver, therebymaking more glucoseavailable to the cells.

Epinephrine (Adrenalin) andNorepinephrine

– Dilation of bronchial tubes– Inhibits digestion response– Prolongs sympathetic nerve

response by 10X– Involved in control of ACTH

and TSH

Epinephrine (Adrenalin) andNorepinephrine• Increase metabolic rate of

most cells, thereby makingmore energy.

• Causing bronchodilation toincrease the flow of air intothe lungs

• Changing blood flowpatterns, causing dilationof the blood vessels to theheart an muscles andconstriction of the bloodvessels to the GI tract.

Epinephrine (Adrenalin) andNorepinephrine• Hypersecretion

– Usually caused by a tumor– Cause of increased blood

pressure and hyperglycemia– Prolonged stress response

Abnormal Adrenal Function• Hyperadrenalism

– Excess activity of the adrenalgland

– Cushing’s Syndrome &Disease

– Pheochromocytoma• Hypoadrenalism (adrenal

insufficiency)– Inadequate activity of the

adrenal gland– Addison’s disease

Abnormal Adrenal Function• Hyperadrenalism

– Excess activity of the adrenalgland

– Cushing’s Syndrome &Disease

– Pheochromocytoma• Hypoadrenalism (adrenal

insufficiency)– Inadequate activity of the

adrenal gland– Addison’s disease

Hyperadrenalism

• Primary Aldosteronism– Excessive secretion of aldosterone by adrenal

cortex• Increased Na+/H2O

– Presentation• headache• nocturia, polyuria• fatigue• hypertension, hypervolemia• potassium depletion

Hyperadrenalism• Adrenogenital syndrome

– “Bearded Lady”– Group of disorders caused by adrenocortical

hyperplasia or malignant tumors– Excessive secretion of adrenocortical steroids

especially those with androgenic or estrogeniceffects

– Characterized by• masculinization of women• feminization of men• premature sexual development of children

Hyperadrenalism• Cushing’s Syndrome

– Results from increased adrenocorticalsecretion of cortisol

– Causes include:• ACTH-secreting tumor of the pituitary

(Cushing’s disease)• excess secretion of ACTH by a neoplasm

within the adrenal cortex• excess secretion of ACTH by a malignant

growth outside the adrenal gland• excessive or prolonged administration of

steroids

Hyperadrenalism• Cushing’s Syndrome

– Characterized by:• truncal obesity• moon face• buffalo hump• acne, hirsutism• abdominal striae• hypertension• psychiatric disturbances• osteoporosis• amenorrhea

Hyperadrenalism

• Cushing’s Disease– Too much adrenal hormone production

• adrenal hyperplasia caused by an ACTHsecreting adenoma of the pituitary

– “Cushingoid features”• striae on extremities or abdomen• moon face• buffalo hump• weight gain with truncal obesity• personality changes, irritable

Hyperadrenalism• Cushing’s Syndrome

– Management• Airway/Ventilation/Oxyge

n• Supportive care• Assess for cardiovascular

event requiring treatment– severe hypertension– myocardial ischemia

Hyperadrenalism

• Pheochromocytoma– Catecholamine secreting tumor of adrenal

medulla– Presentation

• Anxiety• Pallor, diaphoresis• Hypertension• Tachycardia, Palpitations• Dyspnea• Hyperglycemia

Hyperadrenalism

• Cushing’s Disease– Too much adrenal hormone production

• adrenal hyperplasia caused by an ACTHsecreting adenoma of the pituitary

– “Cushingoid features”• striae on extremities or abdomen• moon face• buffalo hump• weight gain with truncal obesity• personality changes, irritable

Hyperadrenalism• Cushing’s Syndrome

– Management• Airway/Ventilation/Oxyge

n• Supportive care• Assess for cardiovascular

event requiring treatment– severe hypertension– myocardial ischemia

Hyperadrenalism

• Pheochromocytoma– Catecholamine secreting tumor of adrenal

medulla– Presentation

• Anxiety• Pallor, diaphoresis• Hypertension• Tachycardia, Palpitations• Dyspnea• Hyperglycemia

Hyperadrenalism

• Pheochromocytoma– Management

• Supportive care based upon presentation• Airway/Ventilation/Oxygen• Calm/Reassure• Assess blood glucose• Consider beta blocking agent - Labetalol• Consider benzodiazepines

Hypoadrenalism

• Adrenal Insufficiency– decrease production of glucocorticoids,

mineralcorticoids and androgens• Causes

– Primary adrenal failure (Addison’sDisease)

– Infection (TB, fungal, Meningococcal)– AIDS– Prolonged steroid use

Hypoadrenalism• Presentation

– Hypotension, Shock– Hyponatremia, Hyperkalemia– Progressive Muscle weakness– Progressive weight loss and anorexia– Skin hyperpigmentation

• areas exposed to sun, pressure points, jointsand creases

– Arrhythmias– Hypoglycemia– N/V/D

Hypoadrenalism

• Management– Airway/Ventilation/Oxygen– ECG monitor– IV fluids– Assess blood glucose - D50 if hypoglycemic– Steroids

• hydrocortisone or dexamethasone• florinef (mineralcorticoid)

– Vasopressors if unresponsive to IV fluids