kelainan coreteks adrenal

7/23/2019 Kelainan Coreteks Adrenal

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Kelenjar Adrenal danpermasalahannyadr. Nur Anna C Sadyah SpPD FINASIM



TheEndocrine

System



Adrenal Cortex (outer region

! "he adrenal #ortexse#retes $ steroids%

! &. 'lu#o#orti#oids

! . Mineralo#orti#oids

! $. Sex )ormones



'lu#o#orti#oid

! De#reases in*ammation response

! De#reases stress o+%

! ",! Pneumonia

! Arthritis

! Asthma! allergies



'lu#o#orti#oid

! Slo-s the healing pro#essde#reases resistan#e tosome diseases

! "hey assist to ensure asteady supply o+ glu#ose +orthe /rain and other #ells.

! "he primary glu#orti#oid is

#ortisol also #alledhydro#ortisone (stresshormone



'lu#o#orti#oid

! Indi#ation +or the release o+ this hormone.

! &. Disease

! . Physi#al injury! $. )emorrhage

! 0. In+e#tion

! 1. Pregnan#y

! 2. 3xtreme temperature

! 4. 3motional stress (rage and anger




! )ypose#retion 5 #ortex degeneration6 Addison7s disease (adrenal insu8#ien#y

! A. generali9e -ea:ness

! ,. mus#le atrophy

! C. se;ere *uid loss

! D. /ron9ing o+ the s:in

! 3. Must /e tx -ith steroids < *uids




6 )ypogly#emia andde#reased /lood pressure

6 De#reased Na= andin#reased K= pro/lems

6 >nusual s:in pigmentation(pat#hes o+ #olor



Adrenal Cortex

! )yperse#retion o+ glu#o#orti#oids6 Cushing7s syndrome

6 ?/esity

6 ,u@alo hump 5 +at deposited a#ross theshoulders

6 Moon +a#ed 5 o+ten *ushed

6 A/dominal striations 5 stret#h mar:s

6 )ea;y a/domen and s:inny legs6 "hin s:in that /ruises easily



)yperse#retion o+

glu#o#orti#oids! "he pri#e o+ enhan#edathleti# per+orman#e is high.Se;ere and irre;ersi/lehealth pro/lems su#h as%

! A. #an#er

! ,. osteoporosis (/oneso+tening

! C. mental illness! All are #ompli#ation o+

hyperse#retion.



Adrenal Cortex

! )yperse#retion o+ gonado#orti#oids

6 Adrenogenital syndrome

6 Female /a/y%! De;elopment o+ pu/i# hair

! 3nlarged #litoris

! 3nlarged la/ia majora

! Sex #an /e #on+used as a male



Adrenal Cortex

6 Males%! Premature de;elopment

! 3nlarged penis

! 3arly sex dri;e

! 3x#ess /ody hair



Adrenal Cortex

6 Females! Mas#ulini9ation and

premature de;elopment

! Fa#ial and /ody hair gro-th

(mas#uline! Deeper ;oi#e and re#edinghairline

! De#rease in /reast si9e andin#rease in #litoris si9e



Mineralo#orti#oids

! "he #hie+ mineralo#orti#oid isaldosterone.

! Its role is regulation o+%

! A. /lood ;olume

! ,. /lood pressure



Mineralo#orti#oids

! "he primary targetedorgan is the :idney

! Aldosterone #onser;essodium and -ater andeliminates potassium.



Sex )ormones ('onado#orti#oids

! Not se#reted until pu/erty

! Produ#tion stimulated /ythe gonad hormones

! ?+ the gonad hormonestestosterone is dominant

! Normally produ#tion is

small



Sex )ormones

('onado#orti#oids! Bhen se#reted the +emalehormone is #alledestrogens.

! Bhen se#reted the malehormone is #alledandrogens



Adrenal Medulla

! Se#retes hormones

! &. 3pinephrine (adrenalin

! . Norepinephrine

! "hese hormones arealso :no-n as

#ate#holamines. "hesehormones are se#reted instress situations



Adrenal Medulla

6 Classied as Amine typehormones E o+ se#retionis epinephrine

6 Produ#tion stimulated /ystress

6 Gelated to the sympatheti#hal+ o+ the autonomi#ner;ous system



3pinephrine (Adrenalin and

Norepinephrine! Fun#tions

6 In#reases /lood pressureheart output and

respiratory rate6 In#reases /lood sugarH)o- Con;erting gly#ogento glu#ose in the li;erthere/y ma:ing moreglu#ose a;aila/le to the#ells.




Norepinephrine6 Dilation o+ /ron#hial tu/es

6 Inhi/its digestion response

6 Prolongs sympatheti# ner;e

response /y &EJ6 In;ol;ed in #ontrol o+ AC")

and "S)




Norepinephrine! In#rease meta/oli# rate o+most #ells there/y ma:ingmore energy.

! Causing /ron#hodilation to

in#rease the *o- o+ air intothe lungs

! Changing /lood *o-patterns #ausing dilation o+

the /lood ;essels to theheart an mus#les and#onstri#tion o+ the /lood;essels to the 'I tra#t.




Norepinephrine! )yperse#retion

6 >sually #aused /y a tumor

6 Cause o+ in#reased /lood

pressure andhypergly#emia

6 Prolonged stress response



A/normal Adrenal Fun#tion

! )yperadrenalism

6 3x#ess a#ti;ity o+ the adrenalgland

6 Cushings Syndrome <Disease

6 Pheo#hromo#ytoma

! )ypoadrenalism (adrenal

insu8#ien#y6 Inadeuate a#ti;ity o+ theadrenal gland

6 Addisons disease



)yperadrenalism

! Primary Aldosteronism6 3x#essi;e se#retion o+ aldosterone /y adrenal

#ortex

! In#reased Na=L)?

6 Presentation

! heada#he

! no#turia polyuria

! +atigue

! hypertension hyper;olemia

! potassium depletion



)yperadrenalism

! Adrenogenital syndrome

6 ,earded adyO

6 'roup o+ disorders #aused /y adreno#orti#alhyperplasia or malignant tumors

6 3x#essi;e se#retion o+ adreno#orti#al steroidsespe#ially those -ith androgeni# or estrogeni#e@e#ts

6 Chara#teri9ed /y

!mas#ulini9ation o+ -omen

! +emini9ation o+ men

!premature sexual de;elopment o+ #hildren



)yperadrenalism

! Cushings Syndrome6 Gesults +rom in#reased adreno#orti#al se#retion

o+ #ortisol

6 Causes in#lude%

! AC")5se#reting tumor o+ the pituitary(Cushings disease

! ex#ess se#retion o+ AC") /y a neoplasm-ithin the adrenal #ortex

! ex#ess se#retion o+ AC") /y a malignantgro-th outside the adrenal gland

! ex#essi;e or prolonged administration o+steroids



)yperadrenalism

! Cushings Syndrome

6 Chara#teri9ed /y%

! trun#al o/esity

!moon +a#e

!/u@alo hump!a#ne hirsutism

!a/dominal striae

!hypertension

!psy#hiatri# distur/an#es

!osteoporosis

!amenorrhea



)yperadrenalism

! Cushings Disease

6 "oo mu#h adrenal hormone produ#tion

!adrenal hyperplasia #aused /y an AC")

se#reting adenoma o+ the pituitary6 Cushingoid +eaturesO

!striae on extremities or a/domen

!moon +a#e

!/u@alo hump

!-eight gain -ith trun#al o/esity

!personality #hanges irrita/le



)yperadrenalism

! Cushings Syndrome

6 Management

! Air-ayLentilationL?xyge

n! Supporti;e #are

! Assess +or #ardio;as#ulare;ent reuiring

treatment6 se;ere hypertension

6 myo#ardial is#hemia



)yperadrenalism

! Pheo#hromo#ytoma6 Cate#holamine se#reting tumor o+ adrenal

medulla

6 Presentation

! Anxiety! Pallor diaphoresis

! )ypertension

! "a#hy#ardia Palpitations

! Dyspnea! )ypergly#emia



)yperadrenalism

! Cushings Disease

6 "oo mu#h adrenal hormone produ#tion

!adrenal hyperplasia #aused /y an AC")

se#reting adenoma o+ the pituitary6 Cushingoid +eaturesO

!striae on extremities or a/domen

!moon +a#e

!/u@alo hump

!-eight gain -ith trun#al o/esity

!personality #hanges irrita/le



)yperadrenalism

! Cushings Syndrome

6 Management

! Air-ayLentilationL?xyge

n! Supporti;e #are

! Assess +or #ardio;as#ulare;ent reuiring

treatment6 se;ere hypertension

6 myo#ardial is#hemia



)yperadrenalism

! Pheo#hromo#ytoma6 Cate#holamine se#reting tumor o+ adrenal

medulla

6 Presentation

! Anxiety! Pallor diaphoresis

! )ypertension

! "a#hy#ardia Palpitations

! Dyspnea! )ypergly#emia



)yperadrenalism

! Pheo#hromo#ytoma6 Management

! Supporti;e #are /ased upon presentation

! Air-ayLentilationL?xygen

! CalmLGeassure

! Assess /lood glu#ose

! Consider /eta /lo#:ing agent 5 a/etalol

! Consider /en9odia9epines



)ypoadrenalism

! Adrenal Insu8#ien#y

6 de#rease produ#tion o+ glu#o#orti#oidsmineral#orti#oids and androgens

! Causes

6 Primary adrenal +ailure (Addisons Disease

6 In+e#tion (", +ungal Meningo#o##al

6 AIDS6 Prolonged steroid use



)ypoadrenalism

! Presentation6 )ypotension Sho#:

6 )yponatremia )yper:alemia

6 Progressi;e Mus#le -ea:ness

6 Progressi;e -eight loss and anorexia6 S:in hyperpigmentation

!areas exposed to sun pressure points joints and#reases

6 Arrhythmias

6 )ypogly#emia

6 NLLD



)ypoadrenalism

! Management

6 Air-ayLentilationL?xygen

6 3C' monitor

6 I *uids6 Assess /lood glu#ose 5 D1E i+ hypogly#emi#

6 Steroids

! hydro#ortisone or dexamethasone

! *orine+ (mineral#orti#oid

6 asopressors i+ unresponsi;e to I *uids

kelainan coreteks adrenal

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