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Thursday, November 1, 2012

Disturbance of Suprarenal Cortex


Hyperaldosteronism (aldosteronism)
Hyperaldrenalism (Cushing Syndrome)
Hypoadrenalism (Addison's Disease)
Adrenogenital Syndrome

Hyperaldosteronism (Aldosteronism)

TYPES
    A) Primary Aldosteronism (Conn's syndrome)
          - due to Tumor of Zona Glomerulosa Cells leads to secretion  
            of large amounts of aldosterone

    B) Secondary Aldosteronism
          - Stimulation of renin-angiotensin system (eg heart failure & 
             renal failure)
          - Decreased degradation of aldosterone by liver ( eg Hepatic 
            Failure) 

CLINICAL FEATURES
  1. Cardiovascular - Hypertension due to Na retention
  2. Blood 
    • Increase plasma [Na] - leads to increase blood volume
    • Decrease plasma [K] - hypokalamia
    • Excess Hydrogen secretion - Alkalosis



Hyperaldrenalism (Cushing's Syndrome) - due to increase circulating levels of glucocorticoids / increased androgen or estrogen levels
               
TYPES
     A) Primary (ACTH-independent)
            - due to adrenal adenoma / carcinoma

     B) Secondary  (ACTH dependent)
           - due to ecxcess secretion at CRH / pituitary tumor

CLINICAL FEATURES
  1. Metabolic changes 
    • Increased BMR
    • Fat Metabolism
    • Carbohydrate Metabolism
    • Protein Metabolism
  2. Skin changes
    • development of prple Stria
    • In Secondary Cushing's Syndrome, there will be Skin pigmentation & Hirsutism
  3. Cardiovascular Changes
    • hypertension
    • Edema & Increased Capillary Fragility
  4. Blood Changes
    • Mild polycythemia
    • Mild Lymphopenia
  5. Disturbance of Reproductive Functions
    • Amenorrhea (Irregular Menstruation in Females)
    • Impotence (in Males)

Hypoadrenalism ( Addison's Disease)
 
CAUSES
  - failure/destruction of adrenal cortex due to :
           a) Autoimmune disease
           b) T.B

CLINICAL FEATURES
  1. Metaboilic Changes ( due to cortisol deficiency)
    • Decreased BMR
    • Hypoglycemia
    • Failure of kidney diuresis
    • weakness of skeletal muscle
  2. Manifestation due to aldosterone deficiency
    • Excessive loss of Na in urine cause hypovolemia & hypotension
    • H retention lead to acidosis
    • hyperkalemia
  3. Pigmentation of the skin & mucous membranes
    • caused by direct action of ACTH on melanocytes 
    • More prominent in 
      • light expose areas (eg face , front of neck, back of hands)
      • Pressure points ( eg Back of trunk, elbow, front of knee)
  4. Gastrointestinal Symptoms
    • anorexia, nausea,vomiting,diarrhea
  5. Addisonian crisis
    • Patient are exposed to stress ( eg trauma, illness, surgery), thus patient can't tolerate with it, and falls severely ill, weakened & shocked
    • Treatment 
      • Saline infusion
      • High doses of cortisol & aldosterone
      • Eliminate the stress


Adrenogenital Syndrome

CAUSES
  - Tumour of adrenal cortex that secretes excessive amounts of androgens

CLINICAL FEATURES
  1. In females
    • Virilism (Adult)
      • appearance of male secondary sex characters
      • Characterized by :
        • hirsutism
        • deepness of voice
        • amenorrhea
        • hypertrrophy of clitoris with atrophy of external genitalia
    • Pseudo-Hermaphroditism (before Puberty)
      • born with genetic constitution and gonads of females butt with external genitalia of males
      • signs of virilism develop later in life
  2. In Males
    • Precocious pseudo-puberty( males before Puberty)
      • early development of male secondary sex characteristic without testicular growth
    • No affect (Adult)


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