ADRENAL AND OTHER ENDOCRINE SYSTEM

A OVERVIEW

Dr Saravanakumar

Major endocrine systems in the body

Thyroid gland Parathyroid , calcitonin Pancreas Adrenal gland Pituitary gland The gonads Others Kidney , heart , pineal gland

Adrenal gland - Anatomy

Function

Adrenal medulla - secretes adrenalin , nor adrenalin , dopamine

Adrenal cortex - steroid hormones 1. mineralocorticoids- aldosterone 2. glucocorticoids –cortisol , corticosterone3. sex hormones – DHEA ,androstenedione

Incidentaloma Definition Incidentaloma is an adrenal mass,

detected incidentally by imaging studies conducted for other reasons.

Prevalence -incidentalomas

Imaging study – CT and MRI

TREATMENT

Hypertension , hypokalemia , suppressed reninactivity , female predominanceLAB tests and imaging aid the diagnosis

TREATMENT Spironolatone,Anti Hypertensive'ssurgery

Cushing's syndrome ACTH Dependent

1) Pituitary adenoma – Cushing's disease 2) ACTH Secreting tumours – small cell lung

Ca,foregut carcinoid ,pancreatic Neuroendocrine tumours , medullary Ca thyroid

ACTH independent – adrenal tumours

Treatment Medical therapy

with metyrapone or ketoconazole

trans-sphenoidal resection or radiotherapy

Adrenalectomy- unilateral or bilateral

Adrenal carcinoma Primary – very rare Bimodal age

distribution, female predominance

Poor prognosis Difficulty in diagnosis 60 % Cushing's synd. Surgery followed by

chemo and radiotherapy

Secondary breast, lung, renal,

gastric, pancreatic, ovarian and colorectal cancer

Treat the primary

Disorders of adrenal medulla

Pheochromocytoma Paraganglioma

Pheochromocytoma Pheochromocytoma is known as the ’10 per

cent tumour’ as 10 per cent of tumours are inherited, 10 per cent are extra-adrenal, 10 per cent are malignant, 10 per cent are bilateral and 10 per cent occur in children

Hereditary Pheochromocytoma -Multiple endocrine neoplasia type 2 (MEN 2),Familial paraganglioma (PG) syndrome, von Hippel–Lindau (VHL) syndrome, Neurofibromatosis (NF) type 1

SWISS CHEESE CONFIGURATION

IN CT123I-MIBG

(metaiodobenzylguanidine)

single-photon emission computed tomography

(SPECT)

MANAGEMENT

To start with α-blocker (phenoxy benzamine)

Add β blocker if necessary Plan for surgery Yearly lifelong follow up

Other tumours 1) Neuroblastoma 2) Ganglioneuroma