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Slide 1 :
ADRENAL DISORDERS Dr. Wasi shaikh ( DNB – resident )
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I. Introduction Adrenal Glands suprarenal – they sit on top of the kidneys each is composed of 2 distinct regions: A. Adrenal Medulla - the inner region - comprises 20% of the gland - secretes epinephrine and norepinephrine - derived from ectoderm
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B. Adrenal Cortex the outer region comprises 80% of the gland secretes corticosteroids derived from mesoderm
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1) Zona Glomerulosa (outermost region) - produces mineralocorticoids (aldosterone) 2) Zona Fasiculata (middle region) - produces glucocorticoids (cortisol) as well as estrogens and androgens 3) Zona Reticularis (innermost region) - same function as zona fasiculata DHEA – dehydroepiandrosterone an adrenal androgen in females responsible for growth of pubic and axillary hair
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C. Pathologies Associated with Adrenal Androgen Hypersecretion 1.Adrenogenital Syndrome - hyper secretion of androgens or estrogens a) in the adult female: - masculinization (i.e. hirsutism) b) in the female embryo: - female pseudo hermaphroditism c) in the adult male: - no effect d) in young boys: - precocious pseudo puberty
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II. Mineralocorticoids (Aldosterone) A. Functions - promotes reabsorption of Na+ and secretion of K+ from the distal portion of the nephron B. Regulation of Secretion 1. Renin Angiotensin - Angiotensin II stimulates aldosterone secretion 2. Potassium - high levels of K+ induce aldosterone secretion 3. ACTH - no direct role
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C. Pathologies 1. Hypersecretion a. primary hyperaldosteronism - Conn’s syndrome - usually due to a tumor on the gland - too much secretion of gland itself b. secondary hyperaldosteronism - default in renin angiotensin system - most common in atherosclerosis of renal arteries 2. Hyposecretion (defer to later)
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III. Glucocorticoids (Cortisol) A. Metabolic Effects - overall effect: increase plasma glucose levels, often at the expense of proteins and fats 1. CHO Metabolism a. gluconeogenesis cortisol helps convert skeletal muscle protein to CHO’s and eventually glycogen b. decrease glucose utilization(anti- insulin effect)
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2. Protein Metabolism - proteins are mobilized by cortisol to be converted to CHO’s in a fasting state - lean body mass decreases 3. Fat Metabolism - cortisol causes lipolysis (inhances catecholamines) - expectations: person will be thin, but if excessive cortisol see unusual fat distribution (i.e. “buffalo hump”) 4. Increases Hunger
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B. Other Effects 1. Fetal Development Cortisol aids in maturation of the lungs, especially with the production of surfactant Maturation of g.i. enzymes
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