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Adrenal Anatomy

Adrenal Anatomy. Outer Cortex – aldosterone secretion Inner Cortex – cortisol and adrenal androgens Medulla - epinephrine. 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

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Adrenal Anatomy

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  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. Causes of Primary Adrenal Insufficiency

  5. 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

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

  7. Adrenal Insufficiency • ½ have other autoimmune endocrine disorders • Contrary is not as common • <1% of Type 1 diabetics have adrenal insufficiency

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

  9. Treatment of Adrenal Insufficiency • Acute Treatment of Adrenal Crisis • Chronic Therapy • Treatment During Concurrent Illness

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