6 The Adrenal gland pathology lecture.ppt

Adrenal pathology

2. Tow functional parts:
.1Cortex :
three zones :
1 - zona glomerulosa : Aldosterone
2 - zona fasciculata : glucocortocoids
3 - zona reticularis : Sex hormones
2 -Medullar:
secretes catecholamine

3. Chemical pathology ( functional)
Hyper function ( Cushing's and Conns
syndrome)
 Hypo function (Addison)
Mixed ( Congenital Adrenal hyperplasia)
Histopathology ( structural)
Hyperplasia
Inflammations
Tumors
…

4. Definition:
Clinical syndrome due to increased
circulatory glucocorticoids.
Causes:

↑
ACTH by pit adenoma
Entopic ACTH

↑
cortisol ( Adrenal tumors or ↑plasia)
Iatrogenic ( steroid therapy)

6. Truncal obesity , buffalo hum, moon face.
Skin: bruising, strea, hursutism
↓wound healing, infections
Hypertension
Proximal muscle weakness
Biochemical findings-:
↑Na , ↓K, hyperglycemia, alkalosis..,

9. Lab investigations-:
.1Blood cortisol ( at 8am and midnight)
.2Plasma ACTH
.324 hrs urinary cortisol
.4Dexamethazone suppression test
.1Measure cortisol
.2Give dexamethazone
.3If cortisol suppressed: pit problem
.4If no suppression : adrenal
.5Glucose and Electrolytes
.6Insulin suppression test.
Clinical
Diagnosis
Radiological
Diagnosis

10. Excessive secretion of aldosterone
independent of renin-angiotensin system
Causes:
Adrenal adenoma
Bilateral hyperplasia
Clinical / biochemical effects:
Water and Na retention: edema and HT
Hypokalemic alkalosis -Low renin

11. Due to stimulation of renin-angiotensin
system.
Seen in-:
Any cause of ↓ albumineamia.
Renal damage ( Ischemia) .
Heart failure.
3 rd space diseases


12. Acute
Sudden withdrawal of
steroids therapy
OR
Waterhouse- Frederickson
syndrome
Chronic
Primary:
Addisons syndrome
OR
Secondary:
Pit or hypothalamus
disorder

13.  Meningococcal septicemia
DIC with widespread purpura
Rapidly progressive hypotension --shock .
 ?causes of adrenal hemorrhage: DIC,
endotoxin-induced vasculitis, bacterial
seeding of small vessels
IF occur in Addison pt called Ad crisis.
high mortality rate

15. Chronic adrenal insufficiency due to
gland destruction
Causes:
Autoimmune ( 90%)
Infections (TB)
Tumors
Amyloid.

16. Clinically
Weakness , tiredness
Wt loss
Loss of hair
Oral pigmentation
Other autoimmune diseases
Biochemical findings
Hypoglycemia

↓
Na, ↑K , acidosis

17. Plasma costisol level
Plasma ACTH and CTRH
Synacthin test: no rise in cortisol after
giving ACTH.
Blood urea and electrolytes
Adrenal antibody screening
Adrenal and pit scanning
Management
?

18. 
Inborn error of metabolism

Deficiency in enzymes needed for hormones
synthesis

Many types:
Classical ( 21 hydroxylase def)
Non classical : others
Clinical and biochemical:

↓
aldosterone and steriods--------Addison
↑Androgens: psudohermaphroiditism
 virilism, hirtutism, infertility


19. Cholesterol
17 HX
Androgens
Aldosterone
21 HX
√

20. Infections -:
TB. Typical granuloma
Viral and bacterial acute ifections
Cortical atrophy: 2 ry to pit ↓function
Diffuse nodular hyperplasia: 2ry to↑ pit
Amyliodosis : deposition of abn proteins
Adrenal neoplasia
Adenoma - Adenocarcinoma

21. Immune Adrenalitis
Commonest cause of hypofunction
Pathology:
Macro: small irregular gland
Micro: atrophy
lymphocytes infelteration
germinal centers
Clinically:
Addison's syndrome

22. Adenoma

Yellow oval mass

Small ( 2 cm)

Cells as Zona fasiculata
Adrenal carcinoma

Very rare

Cause hyperfunction

Well differentiated adenocarcinoma