Adrenal Anatomy

1
Adrenal Anatomy

• Outer Cortex aldosterone secretion
• Inner Cortex cortisol and adrenal androgens
• Medulla - epinephrine

2
Gross Anatomy

• Pyramidal structure
• 2-3 cm wide
• 4-6 cm long
• 1 cm thick
• Usual wt 4 gm (up to 22 gm with chronic illness
  and stress)
• 3 of adults macro-nodules
• 65 of adults microscopic nodules

3
Ectopic Adrenal Tissue

• Cortical Tissue
• Retroperitoneal celiac plexus
• Hilum of spleen
• Ovaries
• Scrotum
• Liver
• Wall of gallbladder
• Cranium

4
(No Transcript)
5
Causes of Primary Adrenal Insufficiency
6
(No Transcript)
7
Autoimmune Adrenalitis

• Humoral and cell-mediated
• Antibodies to 21-hydroxylase or other
  steroidogenic enzymes and all 3 zones of adrenal
  cortex
• Polyglandular 70 females
• Isolated autoimmune 71 males in first 2
  decades, equal in 3rd decade and 81 female
  subsequently

8
Adrenal insufficiency

• First indication increased plasma renin with nl
  or low serum aldo zona glomerulosa
• Next decreasing cortisol and elevated ACTH

9
Adrenal Insufficiency

• ½ have other autoimmune endocrine disorders
• Contrary is not as common
• lt1 of Type 1 diabetics have adrenal insufficiency

10
(No Transcript)
11
PGA Type 2

• Much more common
• ½ of cases are familial
• Several modes of inheritance
• 2 times more frequent in women

12
(No Transcript)
13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
(No Transcript)
18
Treatment of Adrenal Insufficiency

• Acute Treatment of Adrenal Crisis
• Chronic Therapy
• Treatment During Concurrent Illness

19
(No Transcript)
20
(No Transcript)
21
(No Transcript)