Adrenal Gland

By Mickey & Billy

Adrenal Gland
Adrenal Cortex Adrenal Medulla

Adrenal Cortex
MINERALOCORTICOIDS GLUCOCORTICOIDS SEX HORMONES

MINERALOCORTICOIDS
Aldosterone (renin from kidneys controls adrenal cortex production of aldosterone)
- Na retention - Water retention - K excretion

GLUCOCORTICOIDS
CORTISOL responsible for control and & metabolism of: a. CHO (carbohydrates) - glucose formed - glucose released

b.FATS-control of fat metabolism

- stimulates fatty acid mobilization from adipose tissue

GLUCOCORTICOIDS

c. PROTEINS-control of protein metabolism - stimulates protein synthesis in liver - protein breakdown in tissues

d. Other functions - inflammatory and allergic response - immune system therefore prone to infection

Cushings syndrome
(TOO MUCH CORTISOL)

ETIOLOGY
Exogenous
- Administration
Ectopic ACTH syndrome refers to excessive ACTH production resulting from an endocrine or nonendocrine tumor, usually of the pancreas, thyroid, or lung (e.g., small-cell lung cancer).

Endogenous

- Overproduction by the adrenal gland (adrenocorticotrophic hormone [ACTH]-dependent) - Overproduction by abnormal adrenocortical tissues eg. adrenal adenomas and carcinomas (ACTH-independent)

Frequency of signs and symptoms in Cushings syndrome

Sign or symptom
Central obesity Hypertension

Occurrence %
94 82

Sign or symptom
Easy bruisability Osteoporosis

Occurrence %
60 60

Glucose intolerance
Hirsutism Amenorrhea or impotency Purple striae

80
75 75 65

Personality changes
Acne Edema Headache

55
50 50 40

Plethoric faces

60

Poor wound healing

40

TREATMENT (Exogenous)
Minimize corticosteroid dose as much as underlying disease control permits Avoid long-acting steroids (e.g., dexamethasone) Restrict dosing to the morning if possible Employ every-other-day dosing if possible Strategy for reducing ("tapering") dose

TREATMENT (Endogenous)
Nonpharmacologic Therapy

The treatment of choice for both ACTH-dependent and ACTH-independent Cushings syndrome is surgical resection of any offending tumors. Pituitary irradiation provides clinical improvement in about 50% of patients, but improvement may not be seen for 6 to 12 months and pituitarydependent hormone deficiencies can occur

TREATMENT (Endogenous)
Pharmacotherapy
Steroidogenic Inhibitors

Used primarily in preparation for surgery, Adjunctive treatment after unsuccessful surgery or radiotherapy, or for refractory patients who are not surgical candidates Should not be used after successful surgery. Metyrapone , Aminoglutethimide, Combine metyrapone and aminoglutethimide, Ketoconazole, Etomidate

Adrenolytic Agents
Mitotane

Neuromodulators of ACTH Release

Combination therapy with these agents may prove more efficacious than any single agent Cyproheptadine, Tretinoin

Glucocorticoid-Receptor Blocking Agents

Mifepristone