Download DISORDERS OF ADRENAL CORTEX

DISORDERS OF ADRENAL CORTEX
Lecture – 2
Dr. Zahoor Ali Shaikh
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DISORDERS OF ADRENAL CORTEX
Adrenal Cortex may secrete hormones in excess [too
much] or too little.
 We will discuss excess of hormone first :
 When there is increased secretion, it will cause
1. Hyperaldosteronism or Conn’s syndrome [increased
aldosterone secretion]
2. Cushing’s syndrome [excess of Cortisol hormone]
3. Adrenogenital syndrome [adrenal androgen hyper
secretion]

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HYPERALDOSTERONISM OR CONN’S
SYNDROME
 Aldosterone hyper secretion may occur due to
aldosterone secreting tumor of adrenal cortex.
 Aldosterone hyper secretion may occur due to
high activity of renin angiotensin aldosterone
system due to chronic reduction of arterial
blood flow to the kidneys [secondary hyperaldosteronism].
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PRIMARY HYPERALDOSTERONISM OR CONN’S
SYNDROME

Conn’s syndrome is characterized by
Na+ retention [hypernateremia]
-
K+ [hypokalemia]
- Hypertension [increased Na+ reabsorption,
therefore increased ECF & blood volume]
-
Decreased Renin secretion
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CUSHING’S SYNDROME
Cushing’s syndrome can be caused by
1. Adrenal tumor [which secretes increased
cortisone independent of ACTH].
2. Increased ACTH secretion by anterior pituitary
[called Cushing Disease].
3. ACTH secreting tumor located in places other
than pituitary, most commonly in lungs.

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CUSHING’S SYNDROME

Cushing’s syndrome is characterized by:
- Increased Cortisol and androgen levels.
- Decreased ACTH [as cortisol secretion increased
by adrenal tumor].
-NOTE : Increased ACTH occurs in pituitary tumor
i.e. Cushing disease].
- Hyperglycemia [due to increased Cortisol].
- Increased protein catabolism and muscle
wasting.
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CUSHING’S SYNDROME [CONT]
Central obesity [abnormal fat deposition, at
face, shoulder blades and abdomen]. They are
called Buffalo hump, and moon face.
 Limbs remain thin.
 Loss of muscle protein leads to muscle
weakness and fatigue.
 Poor wound healing.
 Bruises.

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CUSHING’S SYNDROME [CONT]
Striae in abdomen due to protein poor thin skin
which is over stretched by increased fat
deposition.
 Osteoporosis and bone fracture.
 Hypertension.
 Verilization in women [caused by increased
level of adrenal androgens].

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ADRENOGENITAL SYNDROME
There is enzyme defect commonly 21–
Hydroxylase, therefore, Cortisol is not produced
by adrenal cortex and there is increased ACTH.
 Increased ACTH causes changes in cholesterol
precursor into androgen path way.
 This results in increase in DHEA
[Dehydroepiandrosterone] and androgens.

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ADRENOGENITAL SYNDROME
Due to increased secretion of adrenal sex
hormones which affect genitalia and are
associated with sexual characteristics.
 Effect of androgen will depend according to the
age of patient.

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EFFECT OF HYPERSECRETION OF ADRENAL
ANDROGEN ON NEW BORN FEMALE



Congenital Adrenal Hyperplasia [CAH]
- 21- Hydroxylase Deficiency
- Autosomal Recessive, occurs 1:15000 birth
New born female with Adrenogenital syndrome
manifest ambiguous external genitalia because of
increased androgen secretion occurring during early
fetal life.
It is cause of female PSEUDOHERMAPHRODITISM [a
condition in which ovaries are present but external
genitalia resemble that of male]
NOTE – True HERMAPHRODITE has gonads of both
sexes.
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EFFECT OF HYPERSECRETION OF ADRENAL
ANDROGEN ON ADULT FEMALE
In adult female, hypersecretion of androgen
causes male pattern of body hair called
HIRSUTISM [beard].
 Deepening of voice.
 Muscular arms and legs.
 Breast become smaller.
 Menstruation may stop (due to androgen
negative feed back on hypothalamus –
pituitary – ovarian axis).

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EFFECT OF HYPERSECRETION OF ADRENAL
ANDROGEN ON ADULT MALE

Increased adrenal androgen secretion in adult
male has no apparent effect because
masculinizing effect of DHEA is weak in face of
powerful masculinizing effect of testosterone.
NOTE – Increased androgen inhibit gonadotropins
but not ACTH, therefore, adult patient with
Adrenogenital syndrome are sterile [no
children].
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SUMMARY
In Adrenogenital syndrome, we get symptoms
according to the age, in adult they are:
1. Symptoms of adrenal virilization
2. Sterility
3. Symptoms of Cortisol deficiency

TREATMENT – Glucocorticoids [Cortisol]
 It reverses the virilization, sterility and Cortisol
deficiency by blocking the effect of ACTH.
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WE WILL DISCUSS EFFECT OF LESS
SECRETION OF HORMONES BY ADRENAL
CORTEX
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PRIMARY ADREONOCORTICAL INSUFFICIENCY
OR ADDISON’S DISEASE
Addison’s Disease or Primary Adrenocortical
Insufficiency
 Causes
– Autoimmune disease – 90%, causing
destruction of adrenal cortex, therefore,
aldosterone, Cortisol and sex hormone are
deficient, there is increased ACTH.
- Tuberculosis – 10%

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SECONDARY ADRENOCORTICAL INSUFFICIENCY

Secondary Adrenocortical insufficiency.
- Due to pituitary or hypothalamic abnormality
causing decreased ACTH secretion.
- In this case, only Cortisol and sex hormone are
deficient but aldosterone secretion is not
affected as it does not depend on ACTH.
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ADDISON’S DISEASE
Incidence 3-4 per million per year.
 It is characterized by
- decreased Na+[Hyponatremia]
- increased K+ [hyperkalemia]
- decreased blood pressure
- decreased blood glucose [hypoglycemia]

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ADDISON’S DISEASE [CONT]
- weight loss, weakness
- metabolic acidosis [due to aldosterone
deficiency causing decreased secretion of H+
ion]
- hyper pigmentation [due to increased ACTH.
ACTH contains MSH- melanocyte stimulating
hormone effect]
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SECONDARY ADRENOCORTICAL INSUFFICIENCY
It is due to pituitary disease, therefore, there is
deficiency of ACTH.
 There is no hyper-pigmentation.
 Aldosterone level is normal, therefore Na+, and
K+ changes do not occur.

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WHAT DO YOU KNOW FROM THIS LECTURE?
Conn’s Syndrome or Hyperaldosteronism
 Cushing’s Syndrome [Cortisol Hyper Secretion]
 Cushing Disease
 Adrenogenital Syndrome [Adrenal Androgen Hyper
Secretion]
 Addison’s Disease [Primary Adrenocortical
Insufficiency]
 Secondary Adrenocortical Insufficiency [Due to
Pituitary or Hypothalamic Abnormality]

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THANK YOU
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