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1. SIERRA LEONE GOVERNMENT SCHOOL OF CLINICAL SCIENCES Makambo, Makeni. HISTOPATHOLOGY Diseases of the adrenal LECTURER : Dr . Abu Bakarr Kanu

2. PRESENTERS PETER S SAMURA SALIFU L SAMURA

3. Contents INTRODUCTION OVER VIEW OF THE ANATOMY Disorder of the adrenal glands TUMOURS OF ADRENAL GLANDS

4. INTRODUCTION The Adrenal Gland also known as suprarenal gland are endocrine glands that produce a variety of hormones . They are found above the kidneys. Each gland has an outer cortex which produce steroids hormones (i.e. mineralocorticiods , glucocorticoids, and aldosterone ) and an inner medulla. A number of endocrine diseases involve dysfunctions of the adrenal gland. Like either overproduction or insufficient production of cortisol leads to disorder. Also a variety of tumors can arise from adrenal tissue and leads to a disease.

5. OVER VIEW OF THE ANATOMY • The adrenal glands lie at the upper pole of each kidney. Each gland weighs approximately 4 gm in the adult but in children the adrenals are proportionately larger. •Adrenal is composed of 2 distinct parts: an outer yellow-brown cortex and an inner grey medulla. The anatomic and functional integrity of adrenal cortices are essential for life, while it does not hold true for adrenal medulla.

6. ADDISONS’S DISEASE Addison’s disease is a rare disorder which develops when the adrenal glands do not make enough cortisol. Addison's is an autoimmune disease. Addison’s disease cause damage to the adrenal glands. In the long term, this damage can get worse until eventually the adrenal glands aren't working at all.

7. ETIOLOGY .Primary adrenal insufficiency is caused by hypo function of the adrenal glands  Auto immune response Inadequate secretion of the adrenal hormone Infection of the adrenal hormone Tuberculosis , AIDS, metastatic cancer etc.

8. RISK FACTORS A history of other endocrine disorders Taking glucocorticoids for more than 3 weeks with sudden cessation Taking glucocorticoids more than once every other day Adrenalectomy Tuberculosis

9.  COMPLICATIONS   Hypoglycemia Low levels of cortisol Complications from adrenal crisis: Cardiac arrest Stroke Hypoxia Hypovolemic shock

10. CUSHING SYNDROME Cushing’s  syndrome is a rare disorder that occurs when your body makes too much of the hormone cortisol over a long period of time. Cushing syndrome, may be caused by the use of oral corticosteroid medication

11. ETIOLOGY Extensive use of cortisone medication A benign tumor of adrenal gland Excessive secretion of adrenal androgen A benign tumor of the lungs or other organ Administration of ACTH or corticosteriods

12. CLINICAL MANIFESTATIONS Weight gain and fatty tissue deposits, particularly around the midsection and upper back, in the face (moon face), and between the shoulders (buffalo hump) Pink or purple stretch marks on the skin of the abdomen, thighs, breasts and arms Slow healing of cuts Acne Excess sweating Infertility Muscle weakness

13. COMPLICATIONS Heart attack and stroke Blood clots in the legs and lungs Infections Bone loss and fractures High blood pressure Unhealthy cholesterol levels Depression or other mood changes Memory loss or trouble concentrating Insulin resistance and prediabetes Type 2 diabetes

14. PHEOCHROMOCYTOMA Pheochromocytomas are a type of tumor of the adrenal glands that can release high levels of epinephrine and nor epinephrine. Pheochromocytomas may occur in persons of any age, (mostly in people with hypertension). Pheochromocytomas are, fortunately, quite rare, and most of them are benign.

15. CLINICAL MANIFESTATIONS Hypertension  Headache Heavy sweating Rapid heart beat Tremors Shortness of breadth Panic attacks Weight loss Pallor  

16. COMPLICATIONS • High blood pressure • Heart attack • Heart failure • Stroke • Kidney failure • Cognitive decline • Dementia • Visual impairment

17. TUMOURS OF ADRENAL GLANDS • Primary tumours of the adrenal glands are uncommon and include distinct adrenocortical tumours and medullary tumours . • Adrenal gland is a more common site for metastatic carcinoma

18. ADRENOCORTICAL TUMOURS Cortical Adenoma The commonest cortical tumour is adenoma. They are indistinguishable from hyperplastic nodules except that lesions smaller than 2 cm diameter are labelled hyperplastic nodules. A cortical adenoma is a benign and slow-growing tumour . It is usually small and nonfunctional. Association of cortical adenomas with systemic hypertension has been suggested by some workers.

19. Cortical Carcinoma Carcinoma of the adrenal cortex is an uncommon tumour occurring mostly in adults. It invades locally as well as spreads to distant sites . Most cortical carcinomas secrete one of the adrenocortical hormones excessively.

20. MEDULLARY TUMOURS • The most significant lesions of the adrenal medulla are neoplasms. Benign tumours : These are less common and include pheochromocytoma and myelolipoma . Tumours arising from embryonic nerve cells: These are more common and include neuroblastoma and ganglioneuroma .

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