Adrenal Pathophysiology

Adrenal Disorders
1. HYPERfunction
  1. Hypercortisolism (Cushing's Syndrome)
    1. Most commonly caused by exogenous corticosteroids. Most commonly occurs in women.
    2. Etiologies
      1. Iatrogenic
        ↓cortisol, ↓ACTH, ↓CRH
      2. Cushing's Disease (pituitary adenoma)
        ↑cortisol, ↑ACTH, ↓CRH
      3. Adrenal Adenoma/Carcinoma
        ↑cortisol, ↓ACTH, ↓CRH
      4. Ectopic ACTH-Secreting Tumor
        ↑cortisol, ↑ACTH, ↓CRH
      5. Ectopic CRH-Secreting Tumor
        ↑cortisol, ↑ACTH, ↑CRH
    3. Clinical Effects: Hyperglycemia, T2DM, "Buffalo Hump", "Moon Face", skin atrophy, HTN, Acne, Infertility, Hirsutism (females), depression
  2. Primary Hyperaldosteronism (Conn's Disease)
    1. Due to an aldosterone-secreting adrenal adenoma
      1. Results in: HTN (end-organ-effects: retinopathy, nephropathy, left ventricular hypertrophy), Hypokalemia, Hypervolemia
  3. Secondary Hyperaldosteronism
    1. Due to increased renin production (Heart Failure, CKD, Cirrhosis, etc.)
2. HYPOfunction
  1. Primary Adrenal Insufficiency (Addison's Disease)
    1. Autoimmune: accounts for 80% of adrenal insufficiency
    2. Clinical Effects: Skin bronzing occurs as a result of the up-regulation of ACTH
  2. Secondary Adrenal Insufficiency
    1. Adrenal Crisis: cortical hormones at levels below that which are necessary for survival; Life-Threatening!!!
      1. Treat Immediately!!!
    2. Causes: Infection, Infarction, Iatrogenic Events
Adrenal Cortex: Produces 3 types of Corticosteroid Hormones
1. 1. Glucocorticoids (CORTISOL)
  1. A stress hormone that INCREASES BLOOD PRESSURE, which activates...
    1. Also activates the release of steroids within the liver
2. 3. Mineralocorticoids (ALDOSTERONE)
  1. Increases sodium and water reabsorption
    1. Increases blood volume, INCREASING BLOOD PRESSURE
      1. This antidiuretic effect increases arterial perfusion pressure in the kidneys is what regulates renin release
3. 2. Adrenal Androgen Precursors (DHEA)
Co-Workers
1. Hypothalamic-Pituitary-Adrenal (HPA) Axis
  1. Regulates glucocorticoids and adrenal androgens
  2. Hypothalamus
    1. -- Corticotropin Releasing Hormone (CRH )-->
  3. Anterior Pituitary
    1. -- Adrenocorticotropic Hormone (ACTH) -->
  4. Adrenal Cortex
2. Renin-Angiotensin-Aldosterone System (RAAS)
  1. Regulates mineralocorticoids
  2. Kidney
    1. -- Renin -->
      1. Renin + Angiotensinogen
        --> Angiotensin 1
        Angiotensin 1 + ACE
        --> Angiotensin 2
        Binds to and activates AT2 Receptor
        --> Stimulates release of...
        Causes vasoconstriction, INCREASING BLOOD PRESSURE
        Also activates the release of steroids within the liver
  3. Lungs
    1. -- Angiotensin Converting Enzyme (ACE) -->
  4. Liver
    1. -- Angiotensinogen -->

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Adrenal Pathophysiology

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	Created by Elise Breedlove over 4 years ago