Adrenal Disorder
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Adrenal Disorder

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  • Retroperitoneal gland located close to the upper poles of kidneysSurrounded by renal fascia and separated from the kidneys by perirenal fatRight – pyramidal shape, Left – crescent shape
  • Each gland has yellow-coloured CORTEX and dark brown MEDULLACortex further divided into 3 zones = GFR
  • MNEMONIC: Salt, sugar, and sex: the deeper you go, the sweeter it gets.

Adrenal Disorder Presentation Transcript

  • 1. EXAMINATION AND INVESTIGATION OF ADRENAL DISORDER
    PRESENTED BY:
    GROUP 9
    SUPERVISED BY:
    DR TAN LI PING
  • 2. OUTLINE
    ANATOMY (GROSS & HISTOLOGY)
    PHYSIOLOGY
    ADRENAL DISORDER
    CAUSES
    EXAMINATION
    INVESTIGATION
  • 3. ANATOMY: GROSS
  • 4. ANATOMY: HISTOLOGY
    Mineralocorticoid
    Glucocorticoid
    ZonaGlomerulosa
    Androgens
    ZonaFasciculata
    ZonaReticularis
    Medulla
    Cortex
    Catecholamines
  • 5. PHYSIOLOGY: REGULATION
  • 6. PHYSIOLOGY: MINERALOCORTICOIDS
  • 7. PHYSIOLOGY: GLUCOCORTICOIDS
  • 8. ADRENAL DISORDER
  • 9. ADDISON’S DISEASE
  • 10. AETIOLOGY
  • 11. AETIOLOGY
  • 12. PATHOPHYSIOLOGY
  • 13. HISTORY
    Often diagnosed late
    Weakness, fatigue
    Loss of appetite, loss of weight, anorexia
    Dizziness, syncope
    GI symptom: Nausea, vomiting, abdominal pain, diarrhoea, constipation
    Skin pigmentation (ask if has been sitting in the sun)
    Mood: Depression, psychosis, low self-esteem
    Myalgia, arthralgia
    Addisonian crisis: oliguria, weak, confused, comatose, hypoglycaemic symptoms (cold peripheries, excessive sweating, hunger, syncope)
    * Think of Addison’s in all those with unexplained abdominal symptoms
  • 14. EXAMINATION
    Examine for hyperpigmentation:
    Hand: palmar creases
    Mouth and lips
    Areas usually covered by clothing: nipple
    Areas irritated by belts, straps, collars or rings
    Look for vitiligo
    Look for sparse axillary hair and pubic hair
    Examine the abdomen for adrenal scar
    Examine blood pressure for postural hypotension
    DXT: hypoglycaemia
    Signs of critical deterioration (Addisonian crisis):
    Shock (low BP, tachycardia)
    hypothermia
  • 15. INVESTIGATION: BLOOD
  • 16. INVESTIGATION: IMAGING
  • 17. INVESTIGATION: CONFIRM DIAGNOSIS
    A single depressed plasma cortisol level in a patient who is severely stressed or in shock is highly suggestive of adrenal insufficiency
    Short ACTH stimulation test (Synacthen test):
    Plasma ACTH level
    Plasma ACTH level
  • 18. INVESTIGATION: DIAGNOSIS OF ADDISON’S DISEASE
  • 19. ADDISON’S DISEASE
  • 20. PHAEOCHROMOCYTOMA
  • 21. INTRODUCTION
    Tumour of chromaffin cells
    80% of pheochromocytomas are found in the adrenal medulla, usually benign
    Extra-medulla tumors – 1-3% in chest and neck (usually malignant)
    20% multiple, 10% malignant
    Part of familial syndromes – MEN Type II (Sipple’s syndrome), neurofibromatois and von Hipple-Lindau disease
  • 22. SYMPTOMS AND SIGNS
    Hypertension, may be paroxysmal or persistent. Due to secretion of one or more of catecholamine hormones or precursors: norepinephrine, epinephrine, dopamine or dopa.
    Tachycardia, sweating, postural hypotension, tachypnea, flushing, cold and clammy skin, severe headache, angina, palpitation, dyspnoea
    Paroxysmal attacks may be provoked by exercise, anaesthesia, palpation of tumor, postural changes, urination, beta-blockers
  • 23. DIAGNOSIS
    Screening
    - Two 24 h urines for catecholamines is the best screening investigation
    - 24 h urine for VMA (15% false negative) and metanephrine (10% false negative) - needs vanilla-tree diet before collection
    If the diagnosis is established, or strongly suspected
    MIBG scan - meta-iodo-benzylguanidine labeled with 131I
    - Increased uptake by pheochromocytoma
    CT scan of adrenals - patient should be alpha- and beta-blocked to avoid hypertensive episode after contrast administration