Lecture Notes: Alterations in Hormonal Regulation

Adrenal Glands

• Adrenal Cortex and Cortisol

  • Hypercortical function leads to hypercortisolism.
  • Cushing Syndrome: Chronic excess of cortisol, either from adrenal overproduction or long-term glucocorticoid medication use.
  • Cushing Disease: Excessive ACTH (adrenocorticotropic hormone) secretion by the anterior pituitary gland, often due to a pituitary adenoma.
  • Symptoms:
    • Weight gain, fat accumulation in trunk (truncal obesity), "moon face," "buffalo hump"
    • Increased blood sugar levels, insulin resistance, risk of type 2 diabetes
    • Muscle wasting, weakness, thin skin, easy bruising, slow wound healing
  • Congenital Adrenal Hyperplasia: Genetic disorder resulting in cortisol deficiency and increased ACTH, leading to overproduction of androgens, causing abnormal sexual development.

• Aldosterone

  • Primary Hyperaldosteronism (Conn Syndrome): Overproduction of aldosterone by the adrenal cortex, typically due to adrenal adenoma or hyperplasia.
  • Secondary Hyperaldosteronism: Extra-adrenal stimulus, usually due to reduced kidney blood flow, triggering renin-angiotensin-aldosterone system.
  • Effects:
    • Sodium and water retention, increased blood volume and hypertension
    • Hypokalemia (low potassium levels) due to potassium excretion

• Androgen and Estrogen Disorders

  • Hypersecretion of Adrenal Androgens:
    • Development of secondary male characteristics in females (e.g., facial hair, deep voice)
    • Feminization effects in males (e.g., gynecomastia)
  • Hyposecretion of Adrenal Androgens: Addison's disease (primary adrenal insufficiency)
    • Autoimmune destruction of adrenal cells
    • Symptoms: Fatigue, weight loss, low blood pressure, hyperpigmentation

Adrenal Medulla

• Hyperfunction
  • Catecholamines (epinephrine and norepinephrine) Overproduction: Usually due to adrenal medulla tumors or sympathetic nervous system tumors.
  • Pheochromocytoma: Tumor causing unregulated catecholamine production, leading to exaggerated fight or flight response.
  • Paragangliomas: Tumors from chromaffin cells outside adrenal glands, causing excessive catecholamine production.
  • Symptoms:
    • Hypertension (sustained or paroxysmal), heart rate increase, palpitations, headaches
    • Diaphoresis, tremors, anxiety, panic attacks, weight loss, orthostatic hypotension
  • Diagnosis and Treatment:
    • Plasma or urinary tests for catecholamine breakdown products
    • Imaging (CT or MRI) for tumor location; genetic testing
    • Primary treatment is surgical resection

Conclusion

• Discussion on alterations of hormonal regulation concluded.
• Open for questions if any.