General Pathology Lecture 68: Adrenal Gland Disease

What are the main cells of the adrenal medulla?

Pheochromocytes

What is produced by pheochromocytes in the adrenal medulla?

Epinephrine/Norenephrine

What are the four main functions of cortisol?

1. Glucose regulation

2. Reduce inflammation

3. Immunosupression

4. Fluid retention

What is acute adrenal insufficiency called?

Adrenal crisis

What is chronic adrenal insufficiency called?

Addison disease

What is the primary cause of adrenal insufficiency?

Idiopathic

What are the two secondary causes of adrenal insufficiency?

1. Pituitary hypofunction

2. Chronic intake of corticosteroids

What secretion is decreased with pituitary hypofunction that leads to low cortisol secretion?

ACTH

What is the compensatory reaction to the chronic intake of corticosteroids?

Adrenal gland atrophy

What life threatening symptom is acute adrenal insufficiency associated with?

Adrenal gland atrophy

What is the main cause of acute adrenal insufficiency?

Abrupt withdrawal of high doses of corticosteroids

What is the adrenal gland sepsis syndrome that causes acute adrenal insufficiency?

Waterhouse-Friderichsen syndrome

What postoperative formation could cause acute adrenal insufficiency?

Thrombus

What are the two main features of acute adrenal insufficiency?

1. Hypotension

2. Vascular collapse (Shock)

What is the cause of Addison disease?

Autoimmune

What are the two main features of Addison disease?

1. Electrolyte imbalance

2. Hypotension

What can Addison disease lead to?

Acute adrenal insufficiency

Which adrenal hyperfunction is due to hypercortisolism?

Cushing syndrome

Are most causes of Cushing syndrome exogenous or endogenous?

Exogenous

What is the main exogenous cause of Cushing syndrome?

Excess corticosteroid intake

What is excessively secreted in Cushing syndrome?

Cortisol

What disorders is the gold standard of therapy for chronic intake of corticosteroids?

Dermatologic disorders

What are high doses of corticosteroids used for?

Acute severe flares

What is the main bone feature of Cushing syndrome that causes bone fractures and back pain?

Osteoporosis

What causes cardiac hypertrophy in Cushing syndrome?

Fluid build up

What is the main back feature in Cushing syndrome?

Fat pad

What condition related to obesity is increased in Cushing syndrome?

Diabetes

What are the three features of Cushing syndrome unique to females?

1. Excess facial hair

2. Hair thinning

3. Acne

What is the feature of Cushing syndrome unique to males?

Erectile dysfunction

What is the main risk increased in Cushing syndrome?

Thromboembolism

What are the two main effects of hyperaldosteronism?

1. Increased sodium retention

2. Increased water absorption

What are the three main features of hyperaldosteronism?

1. Hypertension

2. Cardiac disease

3. Hypokalemia

What is the neuroendocrine tumor in the adrenal medulla?

Pheochromocytoma

What cells in the adrenal medulla are affected by pheochromocytomas?

Paraganglioma

What is secreted in excess in pheochromocytoma?

Catecholamines

What percent of pheochromocytomas are malignant?

10%

What is the main feature of pheochromocytoma?

Hypertension

What is the main symptom of catecholamine surge with pheochromocytomas?

Throbbing headache

What test is used to diagnose pheochromocytoma?

24 hour urine test

What should be avoided in dental procedures with patients with pheochromocytoma if their blood pressure remains high?

Epinephrine