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Adrenal Gland
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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 volumealdosteron major regulator of potasium metabolism
GlucocorticoidSynthesis : z. fasiculata z. reticularisGlucorticoid 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 virilismnewborns 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 paratyroidMEN IIIF, hiperplasia tyroid, karsinoma medulary, neuroma, Von hippel lindaukista, RCC, F, angiomatosis, hemagioblastomaVon reklinghausen neurofibromatosis, schwanoma, meningioma, glioma, FSturger 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