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PATHOPHYSIOLOGY OF ADRENOCORTICAL HORMONE

ENDO BLOCK 412. PATHOPHYSIOLOGY OF ADRENOCORTICAL HORMONE. Dr. Shaikh Mujeeb Ahmed Assistant Professor AlMaarefa College. Lecture Objectives. At the end of this lecture the student should be able to Describe Pathophysiology of hypo & hyperpadrenalism

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PATHOPHYSIOLOGY OF ADRENOCORTICAL HORMONE

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  1. ENDO BLOCK 412 PATHOPHYSIOLOGY OF ADRENOCORTICAL HORMONE Dr. Shaikh Mujeeb Ahmed Assistant Professor AlMaarefa College

  2. Lecture Objectives • At the end of this lecture the student should be able to • Describe Pathophysiology of hypo & hyperpadrenalism • Correlate the features of hypo and hyper adrenalism with the physiological action and control mechanism of adrenocortical hormones. • Describe the different stress mechanisms and the body’s response to these stressors.

  3. Pathophysiology

  4. Pathophysiology • primary hyperaldosteronism, or Conn’s syndrome)-Adrenal tumor • Secondary hyperaldosteronism- inappropriately high activity of the renin-angiotensin-aldosterone system • Cortisol hypersecretion - (Cushing’s syndrome) • Adrenal androgen hypersecretion – adrenogenital syndrome,

  5. HYPERALDOSTERONISM • primary hyperaldosteronism, or Conn’s syndrome • Cause: • Adrenal tumor of aldosterone –secreting cells • Secondary hyperaldosteronism • Cause: • inappropriately high activity of the renin-angiotensin-aldosterone system

  6. Symptoms • excessive Na+ retention (hypernatremia) and • K +depletion (hypokalemia). • high blood pressure (hypertension)

  7. CUSHING’S SYNDROME • Cause • Overstimulation of the adrenal cortex by excessive amounts of CRH and/or ACTH, • Adrenal tumors that uncontrollably secrete cortisol independent of ACTH, • ACTH-secreting tumors located in places other than the pituitary, most commonly in the lung

  8. CUSHING’S SYNDROME …. • Features • High blood glucose • Glucosuria – Adrenal diabetes • Protein shortage • Buffalo hump • Moon face • Thin extremities, weakness & fatigue • Reddish – purple linear stria

  9. Before and after onset of Cushing’s disease Before After

  10. Clinical features of Cushing's syndrome

  11. ADRENAL ANDROGEN HYPERSECRETION • Adrenogenital syndrome • In adult females • Male pattern of body hair • Deep voice • Muscular arms & leg • Decrease breast size, menstrual suppression

  12. ADRENAL ANDROGEN HYPERSECRETION • Adrenogenital syndrome • In newborn females • Male type of external genitalia • female pseudohermaphroditism • In pubertal males • prematurely develop male secondary sexual characteristics • precocious pseudopuberty

  13. ADRENAL ANDROGEN HYPERSECRETION • Adrenogenital syndrome • In adult males • No apparent effect

  14. Hormonal interrelationships in adrenogenital syndrome

  15. ADRENOCORTICAL INSUFFICIENCY • Primary adrenocortical insufficiency, also known as Addison’s disease • Autoimmune destruction of cortex • Features are related to Aldosterone deficiency • K retention (hyperkalemia), • Na depletion (hyponatremia), • disturbed cardiac rhythm. • Hypotension

  16. ADRENOCORTICAL INSUFFICIENCY • Features are related to cortisol deficiency • poor response to stress, • hypoglycemia (low blood glucose) • hyperpigmentation (darkening of the skin)

  17. Lecture - 10 Integrated Stress Response General adaptation syndrome

  18. STRESS • It’s a generalized, nonspecific response of the body to any factor that overwhelms, or threatens to overwhelm, the body’s compensatory abilities to maintain homeostasis. • Types • Physical (trauma, surgery, intense heat or cold); • Chemical (reduced O2supply, acidbase imbalance); • Physiologic (heavy exercise hemorrhagic shock, pain); • Infectious (bacterial invasion); psychological or • Emotional (anxiety, fear, sorrow); and • Social (personal conflicts, change in lifestyle).

  19. Action of a stressor on the body

  20. STRESS!!!!!! Distress • comes from bad sources; (-) stress • the stress that the mind and body undergoes when the normal routine is constantly adjusted and altered. Ex: being carnapped holdapped and kidnapped all in a day • There are actually two types of distress: acute stress and chronic stress.

  21. Types of Stress cont’ Acute stress • usually for short time and may be due to work pressure, meeting deadlines pressure or minor accident, over exertion, increased physical activity, searching something but you misplaced it, or similar things. Symptoms of this type of tension are headaches, back pain, stomach problems, rapid heartbeat, muscle aches or body pain.

  22. Types of Stress cont’ Chronic Stress • prolonged stress that exists for weeks, months, or even years. This stress is due to poverty, broken hearts, stressed families and failed marriages, chronic illness and successive failures in life. • People suffering from this type of stress get used to it and may even not realize that they are under chronic stress. • It is very harmful to their health.

  23. Stress Response General adaptation syndrome, or GAS (FIGHT or FLIGHT system) • universal response to the stressors • involved two major systems of the body, the nervous system and the endocrine (or hormonal) system.

  24. Three distinctive stages : Stage 1: Alarm reaction (AR) • the immediate reaction to a stressor (physical or psychological) • the body releases adrenaline and a variety of other psychological mechanisms to combat the stress and to stay in control that is, to bring about the fight or flight response.

  25. Fight or Flight responses • Increased heart rate • Constriction of blood vessels of most viscera and skin • Dilation of blood vessels of heart, lungs and skeletal muscles • Contraction of spleen • Conversion of glycogen into glucose in liver • Sweating • Dilation of airways • Decrease in digestive activities • Water retention and elevated blood pressure

  26. Stage 2: Stage of resistance (SR) • might also be named the stage of adaptation, instead of the stage of resistance • during this phase, if the stress continues, the body adapts to the stressors it is exposed to • Changes at many levels take place in order to reduce the effect of the stressor

  27. Resistance Responses Cortisol • Lypolysis (breakdown of fat stored in fat cells ) • Glyconeogenesis (metabolic pathway that results in the generation of glucose from non-carbohydrate carbon substrates such as pyruvate, lactate, glycerol, and glucogenic amino acids) • Protein catabolism • Sensitive blood vessels • Reduce inflammation IGF • Lipolysis • Glycogenolysis (the catabolism of glycogen by cleavage of a glucose monomer through cleavage with inorganic phosphate to produce glucose-1-phosphate) TH • increased use of glucose to produce ATP

  28. Stage 3: Stage of exhaustion (SE) • the body has run out of its reserve of body energy and immunity. • mental, physical and emotional resources suffer heavily. • body experiences "adrenal exhaustion". • blood sugar levels dec. as the adrenals become depleted, leading to decreased stress tolerance, progressive mental and physical exhaustion, illness and collapse. • In both cases, your body can not adapt & thus exhaustion follows.

  29. Summary of Stress Response !?

  30. Components of Nervous SystemDuring the Stress Response 1. Hypothalamus 2. Pituitary gland -anterior -posterior 3. Adrenal gland -medulla -cortex

  31. Hypothalamus • Regulates homeostatic functions: -body temperature -thirst/urine output -food intake • Influences emotional and behavioral patterns -changes physiological responses based on emotional stimuli (ie: anxiety - heartbeat) • Links the nervous system with the endocrine system -anterior pituitary -posterior pituitary

  32. Endocrine Response Start of response: • Hypothalamus – detects stress begins alarm phase  Autonomic Nervous System - provides the rapid response to stress commonly known as the fight or flight response - engages sympathetic division of the nervous system Sympathetic nerves release adrenaline

  33. Adrenaline Rush effects….

  34. Fix whatever is causing the stress. In cases of blood lost from injury, kidney help minimize loss.. How? 1. Hypothalamus release (1.)antidiuretics hormone (ADH) Purpose: to make the kidney take water from the urine and put it back into the blood 2. Adrenal glands can also make the kidneys move fluid from the urine back into the blood.

  35. Renin - release by the kidney when their blood supply is reduced during alarm phase. Renin + other protein in the blood = angiotensin (which means "blood vessel constricting"). Aldosterone – release by the adrenal cortex of the adrenal gland due to stimulation of angiotensin - makes the kidneys secrete potassium into the urine and reabsorb sodium and water into the blood. What makes them do it? The kidney itself located just below them The hypothalamus and adrenal cortex work together in the resistance phase to replace lost blood volume and send food to damaged cells.

  36. Stress Continuation To heal damaged cell: It uses up its stored glucose. It will need to use its stored carbohydrates, fat, and proteins Hypothalamus and adrenal glands – serve as instructors a.Hypothalamus releases growth hormoneb.adrenal cortex releases cortisol *Both of these hormones tell the body to release stored compounds from body fat, muscles, and the liver.

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