Unit 12- Secretions and Sonographic Appearance (Elie)

What are all of the steroids that the cortex secretes?

• Mineralocorticoids

• Glucocorticoids

• Sex Hormones

What do the mineralocorticoids do?

Regulate electrolyte metabolism

What is the principal mineralocorticoid?

Aldosterone

Aldosterone plays a regulatory effect on what two things?

• Mineral ions in body fluids

• Water content of tissues

What does a low aldosterone result in?

Results in acidosis or lowered pH level

What role do glucocorticoids play in?

Plays a principal role in Carbohydrate Metabolism

What do Glucocorticoids do?

• Promote deposition of glycogen

• Inhibit use of glucose by cells

  • Result is increased blood sugar level

What are the two primary glucocorticoids and what do they do?

• Cortisone

• Hydrocortisone

  • Diminish allergic response

    • Rheumatoid arthritis

    • Rheumatic fever

What are the male and female sex hormones?

• Androgens- Males

• Estrogens- Female

The adrenals secretes both sex hormones regardless _______

Gender

An over secretion has a marked effect and causes what other effect?

A masculinizing effect

• In women - excess facial hair due to an increase in androgens

• In men - accelerated puberty process

What is the adrenal cortex regulated by?

Adrenocorticotropic Hormone – (ACTH) 

What can Hypersecretion of cortical hormones be caused by?

• Pituitary tumor

  • Causing overproduction of ACTH

• Tumor of adrenal cortex

• Cushing’s syndrome

• Conn’s syndrome 

• Adrenogenital syndrome

What is the medulla secretion epinephrine?

Is a heart rate accelerator and contractility

What is the medulla secretion norepinephrine?

Vasoconstrictor- constricts blood vessels

What do both epinephrine and norepinephrine do?

• Both promote glycogenolysis

  • Increase in blood sugar levels

What are the factors that affect secretions?

• Pain

• Emotional stress

• Hypoglycemia

• Hypotension

• Cold

Is the medulla essential for life?

No, is not essential and can be surgically removed

What can Pheochromocytoma cause?

An increased production of medulla hormones

What is the prep for scanning adrenal glands?

• None specifically required

• Fasting 6-8 hours may eliminate bowel gas

Normal adrenal ultrasounds can be difficult due to:

• Small size

• Medial Location

• Surrounding perirenal fat

Adrenal visualization depends on:

• Size of patient

• Amount of surrounding perirenal fat

• Amount and location of bowel gas

• Mobility of patient to various positions

What type of adrenal is easier to identify and separate from the kidney?

Enlarged/ abnormal adrenals

What is the US appearance of the Right Adrenal Gland?

• “Comma” appearance, or triangular shape

• Should not appear rounded

What is the US appearance of the Left Adrenal Gland?

• Flatter, longer appearance

• More medial

• Separate from crus & GE junction

What is being labeled as A?

Right Adrenal Gland

What is labeled as LA in the image above?

Left Adrenal Gland

What is being shown in the image above?

Neonate adrenals- cortex and medulla

What is being shown in this image?

Congenital Adrenal Hyperplasia

What are the sonographic pitfalls of the adrenals?

• Rt. Crus of diaphragm

• Duodenum

• GE junction

• Lobulations / Accessory spleen

• Splenic vessels

• Pancreatic body- tail / lesions

• Retroperitoneal Lymphadenopathy