Adrenalgland.ppt 1

Adrenal GlandDr. Muhartono, M.Kes, Sp.PA

Adrenal gland consists of Cortex : mesoderm, urogenital ridge Medulla neural crestEach adult adrenal gland weighs from 4 to 6 grams.

Cortex adrenalThree definitive cortical zones : Zona glomerulosa, 10% of the cortex Zona fasiculata, 80% Zona reticularis, 10% Z. Glomerulosa mineralocorticoid aldosteron Z. fasiculata glucocorticoid Z. reticularis glucocorticoid

MineralocorticoidSynthesis : z. gromerulosaThe main one : aldosteron major regulator of extracellular fluid volume

aldosteron major regulator of potasium metabolism

GlucocorticoidSynthesis : z. fasiculata z. reticularis

Glucorticoid cortisol Hypothalamus/CRH Hypophyse /ACTHCortisol effect-----------

Pathology of the adrenal cortexHypofungsi cortex adrenal (Hypoadrenalism)

Hyperfungsi cortex adrenal (Hyperadrenalism)

HypoadrenalismMineralo+glucocorticoid Cause : primer sekunder Primer acute adrenocortical hypofungsiPrimer chronic adrenocortical hypofungsiSekunder adrenocortical hypofungsi

Primer acute adrenocortical insuffisiencyWaterhouse-Friderichsen SyndromeCause : meningococcusDIC circulatory collaps

Primer chronic adrenocortical insufficiencyAddisons diseaseCaused by chronic destructive proses adrenal cortexTbc, sarcoidosis, cancerAutoimmune disease

Hyperfungsi adrenal cortexCushing syndromeConns syndromeAdrenal virilism and congenital adrenal hyperplasia (CAH)

Cushing SyndromePathogenesis: Hipophyse Adrenal Ectopic Iatrogenic

Conns syndromeEtiologi: Adenoma producing aldosteron Idiopatic

Adrenogenital Syndrome

Males precocious puberty

females virilism

newborns congenital cortical hyperplasia enymze defect (21hydroxylase deficiency)

adults adrenal cortical adenomas and carcinomas

Adrenal lesionsAdenomaLesi kuning jinggaCystKarsinoma kortek adrenalSangat ganasDiff baik-anaplastikInvasi PD, metastasis kgb, paru

Adrenal medulaPheochrocytoma MENNeuroblastomaGanglioneuroma

feokromositomaJarangKatekolamin dan hipertensi25% di medula, 75% ekstra adrenalSporadik 90%Terkait sindrom 10%

MEN II F, hiperplasia medula adrenal, karsinoma medulary tyroid, hiperplasia C tyroid dan hiperplasia paratyroid

MEN IIIF, hiperplasia tyroid, karsinoma medulary, neuroma,

Von hippel lindaukista, RCC, F, angiomatosis, hemagioblastoma

Lanjutan:Von reklinghausen neurofibromatosis, schwanoma, meningioma, glioma, F

Sturger weber hemangioma kavernosum n trigeminus, F

Tumor 10%10% bilateral10% ekstraadrenal10% anak10% malignancy

Morfologi zeballen

Klinis HipertensiGagal jantungInfark miokardLaboratorium katekolamin urin dan plasmaCT, MRI, USG

Neuroblastoma < 5 tahunSel-sel bentuk bulat kecil dengan latarbelakang neurofibrilerPseudoroette homer wrightDiferensiasi sel ganglion ganglioneuroblastoma-ganglioneuromaMetastasis