KELENJAR ADRENAL

Dr dr Agus Yuwono SpPD,KEMD

Sub Bag Endokrine Metabolik
SMF Ilmu Penyakit Dalam RSUD
ULIN / FK UNLAM Page 1
ADRENAL

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 ADRENAL DISEASE

Cortisol ACTH Cortisol ACTH

Cushings Disease vs Adrenal Tumor

Cushings syndrome. Two causes of hypercortisolism, pituitary-

dependent adrenal hyperplasia and adrenal tumor, are illustrated. A
third cause is ectopic ACTH production by various tumors. Page 9
 PENYAKIT KORTEKS ADRENAL

Sindroma Cushing
Sindroma adrenogenital
Tumor adrenal
Hirsustisme dan virilisasi
Hiperaldosteronisme
Penyakit Conn (primer) & Hiperaldosteron sekunder
Insufisiensi adrenal :
Krisis adrenal
Insufisiensi adrenal kronik primer (penyakit addison)

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 MEDULA ADRENAL (SEL KROMOFIN)

Penghasil katekolamin
Epinefrin
Norepinefrin

Sintesis epinefrin dan norepinefrin

L tirosin ----- Dopa ----- Dopamin ----- Norepinefrin ----- Epinefrin

hidrosilase Dopa dekarbosilasi Donamine oksi N metil tranferase

Penyakit medula adrenal

Feokromositoma
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SINDROMA CUSHING

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 SINDROMA CUSHING
Etiologi:
hiperplasi bilateral (kelainan hipofise)
tumor adrenal,
Iatrogenik
Gejala : truncal obesity, cepat capai, hipertensi,
amernorhoe, hisustisme, strie abdomen, edema,
glukosuria, osteoporosis

Diagnosis
Gejala klinis, kadar kortisol darah/urine
Supression test : dexamethson test, metirapon test
Terapi :
Kausal
Subtitusi hormon paska operasi Page 13
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This adrenal gland removed surgically in a patient with
Cushing's syndrome has been sectioned in half to reveal an
adenoma. Page 15
 What are the symptoms of Cushing's
syndrome?
Obesity - 'trunk'
Facial puffiness, and the face
often looks 'redder' than usual.
Diabetes.
Facial hair in women.
High blood pressure.
Muscle weakness.
Thin skin which bruises easily.
Purple/pink stretch marks may
appear - similar to those seen on
some pregnant women.
Tiredness.
Aches and pains - particularly
backache.
Mood swings - such as being
more irritable, depressed, or
anxious than usual.
Lack of sex drive (libido).
Periods may become irregular, or
stop, in women.
Osteoporosis
Oedema ('water retention') around
ankles.
Excess thirst.
More susceptible to infections.
Affected children tend to be
obese, but grow slowly so are
short for their age.
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 Iatrogenik
TERAPI KORTIKOSTEROID

1. Efek langsung
Obesitas, strie, dan mooface
Kulit tipis
Osteoporosis
Diabetes melitus
2. Respon jaringan
Menurunkan daya tahan tubuh
3. Penekanan HPAC-axis
Respon terhadap stress menurun

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 Diagnosis Tests may include:

Collection of urine over a 24-hour period

to test for cortisol levels

A dexamethasone suppression test

X-rays, scans and other tests to determine

whether there is a tumor in the pituitary or
adrenal glands or another area of the body

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HIRSUSTISME DAN VIRILISME

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 Definition
Alternative names: hypertrichosis,
hirsuties
Hirsutism is defined as excess body hair in
undesirable locations
Vilirism
clitoromegaly
temporal hair recession
a deepening of the voice
hirsutism

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 Differential Diagnosis
Androgen excess, especially polycystic ovary syndrome (PCOS),
androgen-secreting tumor,
Cushing's syndrome,
nonclassical congenital adrenal hyperplasia (NC-CAH),
exogenous androgens
Rare causes of hirsutism include hyperthecosis (a severe form of
PCOS)
acromegaly
extreme androgen excess with insulin resistance due to genetic
mutations in the insulin receptors (eg, Rabson-Mendenhall
syndrome, leprechaunism/Donohue syndrome).
Androgen excess in adult women from exogenous androgens may
be due to anabolic steroid use or androgen overdose in
postmenopausal patients.

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Picture 1. Idiopathic hirsutism in an elderly woman.
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Picture 2. The patient has late-onset congenital adrenal hyperplasia.
She has clinical features similar to those found in polycystic
ovarian syndrome, including hirsutism, acne, obesity, diabetes, and
menstrual irregularities.
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 Causes of hirsutism
Idiopathic hirsutism:

Drug-induced hirsutism: e.g. anabolic steroids, danazol, minoxidil,

metoclopramide, methyldopa, phenothiazines, progestogens and
reserpine.
Ovarian causes:
Polycystic ovary syndrome: Ovarian neoplasms: e.g. luteoma of
pregnancy, arrhenoblastomas, Leydig cell tumors, hilar cell tumors,
thecal cell tumours.
Adrenal causes:
Androgen-producing adrenal tumour
Congenital adrenal hyperplasia.
Cushing's syndrome.
Other causes:
Include anorexia nervosa, prolactinoma, acromegaly,
hypothyroidism, and porphyria.

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Adrenal Virilism is caused by male sex hormones (androgens)
excessively produced by the adrenal gland. This disorder can
occur before birth and can lead to sexual abnormalities. It can
also occur in girls and women later in life. Page 34
HIPERALDOSTERONISME

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 Nama alternatif
aldosteronism,
autonomous hyperaldosteronism,
primary adrenal hyperplasia, PAH,
idiopathic adrenal hyperplasia, IAH,
Conn syndrome, Conn's syndrome,
adrenal aldosteronoma, aldosteronoma,
bilateral adrenal hyperplasia,
renin responsive adenoma, RRA,
aldosterone-producing renin-responsive adenomas, AP-RAs,
primary hyperaldosteronism, PH,
hypertension
secondary hypertension,
aldosterone-producing adenomas, APAs

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 HIPERALDOSTERONISME

Hiperaldosteronisme primer (peny. Conn)

Hipertensi, sakit kepala, edema, dan hipokalemi
Adenoma adrenal
Aldosteron tinggi dan renin rendah
Terapi : spironolaktone
Hiperaldosteronisme sekunder
Renin tinggi, hiperplasi J glomerolus (sindr Bartter)
Krisis adrenal (insufisiensi adrenal akut)
Defisiensi kortisol akut
KU jelak, mual, muntah, diare, hipotensi, dan syok
Terapi : 1 L NaCl 0,9% + Deksametason 4 mg/jam

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 Symptoms:

High blood pressure

Headache
Muscle weakness
Fatigue
Intermittent paralysis
Numbness

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 Signs and tests

Low serum potassium level

Abdominal CT scan that shows adrenal
mass
Elevated plasma aldosterone level
Elevated urinary aldosterone
Low plasma renin activity
ECG that shows abnormalities associated
with low potassium levels

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 Treatment:

Primary hyperaldosteronism resulting from

an adenoma (tumor) is usually treated
surgically.
Dietary sodium restriction and diuretic that
blocks aldosterone action (spironolactone)
In secondary hyperaldosteronism:
medications and diet.

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PHEOKROMOSITOMA

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 PHEOKROMOSITOMA

Etiologi : tumor medula

Gejala : hipertensi, paroksimal, pusing, palpitasi
Diagnosis dugaan :
1. Hipertensi + paroksimal
2. Hiperglikemia
3. EKG : LVH
Diagnosis pasti
VMA urine turun: katekolamin & metanefrine
urine tinggi
Phentolamine test
Tes provoksi : histamin, tyramine
IVP, arteriografi, USG, kadar nor/adrenalin vena cava
Terapi
Operasi tumor
Simtomatif

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Addison's disease

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ADDISON DISEASE

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 Gejala klinis, tergantung kerusakan adrenal
Pelan, usia pertengahan
Hiperpigmentasi daerah terkena sinar matahari
Lesu, letih, lemah
Anoreksia, mual, dan penurunan berat badan
Hipoglikemi dan hipotensi postural
Hipokalemi dan glukosa darah rendah
Diagnosis pasti : ACTH tinggi
Terapi :
Kortisol : Awal dosis tinggi
Pemeliharaan : 25 mg 0 12,5 mg/hari
Fludrokortison (mineralkortioid) 100 mg/hari

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 Diagnosis

Cosyntropin test
Screening: Plasma cortisol 30 to 60 min
after 250 g IM or IV
Confirming
Plasma ACTH or aldosterone
Increment 30 min after 250 g IM or IV
Adrenal imaging

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Addison's disease

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TERIMAKASIH

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