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Endocrine System 2

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Endocrine System 2

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    1. Endocrine System (2) Ema A. Dragoescu, M.D. June 11, 2009

    2. Adrenal Gland Cortex Zona glomerulosa ? aldosterone Zona fasciculata ? cortisol Zona reticularis ? sex hormones Medulla ? cathecolamines (epinephrine)

    3. Adrenocortical Hyperfunction Hormones produced by adrenal cortex: Cortisol Aldosterone Sex hormones (androgens) Syndromes: Cushing Syndrome Hyperaldosteronism (Conn syndrome) Adrenogenital (or virilizing) syndromes

    4. Cushing Syndrome Endogenous Pituitary hypersecretion of ACTH Adrenal hypersecretion of cortisol (adenoma, carcinoma, nodular hyperplasia) Ectopic ACTH (small cell lung cancer) Exogenous 4. Adm. of exogenous glucocorticoids

    5. Adrenal cortical adenoma Functional Cortisol: Cushing syndrome Aldosterone: Conn’s syndrome (primary hyperaldosteronism) Nonfunctional

    6. Cushing Syndrome – Clinical Features Hypertension Weight gain: Truncal obesity “moon” face “buffalo hump” Decreased muscle mass Hyperglycemia Catabolic effect on proteins with loss of collagen: cutaneous striae, easy brusing, osteoporosis Hirsutism, amenorrhea Increased risk of infections (because of decreased immune response)

    7. Dental Management of the Patient Taking Corticosteroids Routine procedures (excluding surgery) a. Good local anesthesia & postoperative pain control if necessary b. Monitor blood pressure during procedure Dental extractions or surgery a. Corticosteroid dose generally will need to be increased, consult patient’s MD prior to the procedure

    8. Hyperaldosteronism Na retention and K excretion ?HTN, hypokalemia Primary (Conn syndrome) Adrenal cortical adenoma Suppression of RAA: plasma renin = low Secondary Due to decreased renal perfusion (renal artery stenosis, arteriolar nephrosclerosis, CHF) Activation of RAA: plasma renin = high

    9. Adrenocortical insufficiency Acute Massive adrenal hemorrhage (DIC, sepsis = Waterhouse-Friderichsen sdr.) Sudden withdrawal of long-term corticosteroid therapy Stress in patients with chronic adrenocortical insufficiency Chronic (Addison disease) Autoimmune, infections (TB, fungal), AIDS, metastatic cancers

    10. Addison disease Progressive weakness GI symptoms: anorexia, vomiting, weight loss Hyperpigmentation Low aldosterone: hyponatremia, hypotension Low cortisol: hypoglycemia Death if untreated

    11. Pheochromocytoma Tumor of adrenal medulla in adults Paroxysmal episodes of hypertension Urinary excretion of of free cathecolamines and their metabolites (VMA) 10% tumor (familial, children, malignant, extra-adrenal, bilateral)

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