Adrenal Gland & Steroid therapy

8/7/2019 Adrenal Gland & Steroid therapy

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Orthopedic Presentation

Course Coordinator: Dr Joeli

Presenter: Abdul Mushib IbrahimID: S080528

1-Adrenal Gland-Anatomy/Physiology

2- Steroid Therapy


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Suprarenal Gland

Is a endocrine gland.

Right suprarenal gland triangular shape.

Left suprarenal gland semilunar shape.


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Anatomical Points

located in the retro-peritoneum situated atop

the kidneys.

Surrounded by an adipose capsule and renalfascia.

Found at the level of the 12th thoracic

vertebra.

Combined Weight: 7 to 10 grams.


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Each adrenal gland is separated into twodistinct structures:

a) Adrenal Cortex-

cortisol, aldosterone,androgens

b) Adrenal Medulla-

epinephrine,norepinephrine


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Anatomy


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Cortex:


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Cortex

Adrenal cortex comprises three zones:

a) Zona Glomerulosa

b) Zona Fasciculata

c) Zona reticularis


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a) Zona Glomerulosa

outermost layer.

Main site for production of mineralocorticoid

Aldosterone*.

*responsible for the long-term regulation of blood

pressure.


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b) Zona Fasciculata

Situated between the glomerulosa and

reticularis.

responsible for producing glucocorticoid

Cotisol.

secretes a basal level of cortisol but can also

produce bursts of the hormone in response to

adrenocorticotropic hormone (ACTH) from the

anterior pituitary. E.g stress.


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c) Zona reticularis

inner most cortical layer.

produces androgendehydroepiandrosterone

(DHEA

) and DHEA

sulfate (DHEA

-S)


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Medulla core of the adrenal gland.

chromaffin cells of the medulla secreteepinephrine and norepinephrine*.

Fight-or-flight response.

to carry this response, the medulla receives inputfrom the sympathetic nervous system-T5T11.

BUT medulla lacks distinct synapses and releases itssecretions directly into the blood.

- Cortisol also promotes epinephrine synthesis in

the medulla.


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Anatomy: Blood supply.

ARTERIAL SUPPLY:

3 arteries supply each adrenal gland:

1-Superior suprarenal artery (is provided by theinferior phrenic artery).

2-Middle suprarenal artery (is provided by the

abdominal aorta).3-Inferior suprarenal artery (is provided by the

renal artery).


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VENOUS DRAINAGE

1-Right suprarenal vein (drains into the inferior

vena cava).2-Left suprarenal vein (drains into the left renal

vein or the left inferior phrenic vein).


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Interesting Fact

The adrenal glands and thyroid gland are the

organs that have the greatest blood supply per

gram of tissue.

60 arterioles may enter each adrenal gland.

This may be one of the reasons lung cancer

commonly metastasizes to the adrenals.


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Things Going Wrong in Adrenals

Conns Syndrome

Cushings Syndrome

Tumors ofAdrenal Cortex: 20%Pituitary Disease: 80%

Ectopic ACTH Production.

Iatrogenic Adrenal Feminization

Phaeochromocytoma


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Any Points for

Discussion ? ? ? ? ?


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Steroid Therapy

Prednisone

Budesonide

Prednisolone

Methylprednisolone

Hydrocortisone

Dexamethasone

Cortisone

Betamethasone


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are potent chemical substances which can

reduce swelling and inflammation quickly.

are closely related to cortisol.


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Are synthetic products.

Mode ofAction: mimic the effects of

hormones produced by adrenal Glands.

When is it Therapeutic:

When prescribed in doses that exceed thebody's usual levels.

It also suppresses the immune system.


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Side effects of Oral Steroids

Elevated pressure in the eyes (glaucoma)

Fluid retention, causing swelling in your lower

legs Increased blood pressure

Mood swings

Weight gain, with fat deposits in yourabdomen, face and the back of your neck


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Side Effects

When taking oral corticosteroids for a longer term:

Cataracts

High blood sugar, which can trigger or worsen diabetes

Increased risk of infections Loss of calcium from bones, which can lead to

osteoporosis and fractures

Menstrual irregularities

Suppressed adrenal gland hormone production

Thin skin, easy bruising and slower wound healing


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Reducing risk of corticosteroid side

effects

Lower doses or intermittent dosing.

Switch to non-oral forms of corticosteroids ifapplicable e.g in Asthma.

Make healthy choices during therapy.

Take care when discontinuing therapy.


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Take care when discontinuing

therapy

Tapering the dosages off.

Explanation: Taking oral corticosteroids forprolonged periods results in adrenal glands

producing less of the natural steroid hormones.

Abrupt Cessation Withdrawal Symptoms-weakness, tiredness, vomiting, diarrhoea,

abdominal pain, low blood sugar, and low bloodpressure which can cause dizziness, fainting orcollapse.


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Dosages

short course of steroids usually causes no side-effects (1-2 week Course).

Side-effects are more likely to occur iftaking a

long course of steroids (more than 2-3 months),or if taking short courses repeatedly.

The higher the dose, the greater the risk of side-effects.

COMMON RX PLAN: start with a high dose tocontrol symptoms then slowly reduce to a lowerdaily dose that keeps symptoms away.


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Indications of Steroid Use

1-Anti-inflammatory

2-Immunosuppressant

3-Replacement therapy

Asthma,allergic rhinitis,Urticaria.

rheumatoid arthritis, lupus, Crohns disease,

ulcerative colitis.

Addisonian Crisis, Hypotension.


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THEEND

VINAKA


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Referance

Textbook of Clinical Oriented Anatomy.

Australian Handbook of Medicine.

Textbook of Physiology.

Adrenal Gland & Steroid therapy

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