PATHOPHYSIOLOGY OF ADRENOCORTICAL HORMONE

PATHOPHYSIOLOGY OF ADRENOCORTICAL HORMONE

Dr. Amel Eassawi

OBJECTIVESAt the end of this lecture the student should be able to: Describe Pathophysiology of hypo and hyperpadrenalism. Correlate the features of hypo and hyper adrenalism with

the physiological action and control mechanism of adrenocortical hormones.

Describe the different stress mechanisms and the body’s response to these stressors.

3

PATHOPHYSIOLOGY

Adrenocortical hormones

Hyper secretion

Aldosterone

Conn’sSec.Hyper

Aldosteronism

Cortisol

Cushing’ssyndrome

DHEA

AdrenogenitalSyndrome

Hyposecretion

Addison’sDisease

4

PATHOPHYSIOLOGY

• Primary hyperaldosteronism, or Conn’s syndrome)-Adrenal tumor.

• Secondary hyperaldosteronism- inappropriately high activity of the renin-angiotensin-aldosterone system.

• Cortisol hypersecretion - (Cushing’s syndrome).• Adrenal androgen hypersecretion – adrenogenital

syndrome.

5

HYPERALDOSTERONISM• Primary hyperaldosteronism, or Conn’s syndrome

– Cause:• Adrenal tumor of aldosterone –secreting cells

• Secondary hyperaldosteronism– Cause:

• inappropriately high activity of the renin-angiotensin-aldosterone system.

Symptoms:• excessive Na+ retention (hypernatremia) and • K +depletion (hypokalemia). • high blood pressure (hypertension)

6

CUSHING’S SYNDROME

• Cause– Overstimulation of the adrenal cortex by excessive

amounts of CRH and/or ACTH,– Adrenal tumors that uncontrollably secrete

cortisol independent of ACTH, – ACTH-secreting tumors located in places other

than the pituitary, most commonly in the lung

7

CUSHING’S SYNDROME

• Features– High blood glucose– Glucosuria – Adrenal diabetes– Protein shortage– Buffalo hump– Moon face– Thin extremities, weakness & fatigue– Reddish – purple linear stria

8

CUSHING’S SYNDROME

9

CUSHING’S SYNDROME

AfterBefore

10

CLINICAL FEATURES OF CUSHING'S SYNDROME

11

ADRENAL ANDROGEN HYPERSECRETION

• Adrenogenital syndrome• In adult females

– Male pattern of body hair– Deep voice– Muscular arms & leg– Decrease breast size, menstrual suppression

12

ADRENAL ANDROGEN HYPERSECRETION

• Adrenogenital syndrome• In newborn females

– Male type of external genitalia– female pseudohermaphroditism

• In pubertal males– prematurely develop male secondary sexual characteristics– precocious pseudopuberty

• In adult males– No apparent effect

13

Hormonal interrelationships in adrenogenital syndrome

14

ADRENOCORTICAL INSUFFICIENCY• Primary adrenocortical insufficiency, also known as Addison’s

disease– Autoimmune destruction of cortex

• Features are related to Aldosterone deficiency– K+ retention (hyperkalemia), – Na+ depletion (hyponatremia), – disturbed cardiac rhythm.– Hypotension

• Features are related to cortisol deficiency– poor response to stress, – hypoglycemia (low blood glucose)– hyperpigmentation (darkening of the skin)

References

Human physiology, Lauralee Sherwood, seventh edition.

Text book physiology by Guyton &Hall,11th edition.

Text book of physiology by Linda .S .Costanzo third edition

15