Adrenal Gland Disorders Powerpoint presentation

Adrenal gland disorders

1. Adrenal Gland Disorders Dr Tajamul Rashid Assistant Professor, Surgery HIMSR, Delhi

2. Adrenal Cortex Adrenal Medulla Hyperaldosteronism Pheochromocytoma Cushing’s syndrome Incidentaloma Adrenocortical cancer Sex steroid excess Incidentaloma

3. Hyperaldosteronism Primary: Autonomous aldosterone secretion  suppression of renin secretion Causes: Adrenal adenoma, idiopathic B/L hyperplasia, adrenocortical carcinoma, FAMILIAL Secondary: Renal artery stenosis, low flow states like CHF or cirrhosis

4. Symptoms & signs Hypertension Muscle weakness Polydipsia Polyuria Nocturia Headaches & fatigue

5. Diagnosis All medications should be with held if possible Hypokalemia Elevated plasma aldosterone level with suppressed plasma renin activity Unilateral aldosteronoma vs bilateral hyperplasia (Selective venous catheterization)

6. Radiological studies CT MRI PET CT

7. Treatment Control hypertension (Spironolactone) Tumors : Surgery B/L hyperplasia: Medical management

8. Cushing’s syndrome & disease Cushing’s syndrome : Symptoms & signs resulting form hypersecretion of cortisol regardless of etiology Cushing’s disease : B/L adrenal hyperplasia & hypercortisolism due to a pituitary tumor (adenoma)

9. Causes ACTH Dependent (70%) ACTH Independent (20-30%) Pituitary adenoma (70%) Adrenal adenoma (10-15%) Ectopic ACTH Production(10%) Adrenal carcinoma (5-10%) Ectopic CRH production(<1%) Adrenal hyperplasia (5%)

10. Signs & symptoms System Manifestation General Weight gain, central obesity, buffalo hump Integumentary Hirsutism , purple striae , acne, echymosis CVS HTN Musculoskeletal Weakness, osteopenia Neuropsychiatric Emotional lability , psychosis, depression Metabolic Diabetes, hyperlipidemia Renal Polyuria, renal stones Gonadal Impotence, decreased libido, menstrual irregularities

11. Diagnosis Elevated glucocorticoids, not suppressed by exogenous administration of hormonal administration with loss of diurnal variation Plasma ACTH: Dependent/independent CRH CT & MRI

12. Treatment Treat the cause

13. Adrenocortical cancer Very rare: 2 per million Bimodal age distribution (Children & 4 th & 5 th decade) Sporadic > genetic (p53, MEN1)

14. Signs & symptoms 50 %  non functioning, enlarging abdominal mass, pain 50 % functioning: Cortisol (30%), androgens (20%), estrogens (10%), aldosterone (2%), multiple harmones (35%)

15. Diagnosis Harmonal essays CT & MRI Size of the tumor : Single most important factor to predict malignancy (>6cm)

16. Treatment Surgery: Laparoscopic/open (R0 resection) Surgical debulking : Isolated recurrent disease EBRT: Recurrence/Metastasis Chemotherpay : Doxorubicin, etoposide , cisplatin Gossypol (Insecticide) Ketoconazole, metyrapone , aminoglutethemide ( Streiods )

17. Sex steroid excess Labs: DHEA (Androgen precursor) Females: Urinary 17-ketosteriods, estrogens

18. Incidentaloma Adrenal lesions discovered during imaging for unrelated reasons Incidence 0.4-4.4%

19. Differential diagnosis Functioning lesions Non-functioning lesions Benign Aldosteronoma Cortisol producing adenoma Sex steroid producing adenoma Pheochromocytoma Benign Cortical adenoma Myelolipoma Cyst Ganglioneuroma Hemorrhage Malignant Malignant Adrenocortical cancer Malignant pheochromocytoma Metastasis Adrenocortical cancer

20. Diagnostic evaluation & treatment

21. Adrenal insufficiency

22. Thank you