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

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

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