Adrenal gland consists of Cortex : mesoderm, urogenital ridge Medulla neural crest Each adult adrenal gland weighs from 4 to 6 grams.
m r f g Cortex adrenal Three 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 Mineralocorticoid Synthesis : z. gromerulosa The main one : aldosteron major regulator of extracellular fluid volume aldosteron major regulator of potasium metabolism Glucocorticoid Synthesis : z. fasiculata z. reticularis Glucorticoid cortisol Hypothalamus/CRH Hypophyse /ACTH Cortisol effect----------- Pathology of the adrenal cortex Hypofungsi cortex adrenal (Hypoadrenalism) Hyperfungsi cortex adrenal (Hyperadrenalism) Hypoadrenalism Mineralo+glucocorticoid Cause : primer sekunder Primer acute adrenocortical hypofungsi Primer chronic adrenocortical hypofungsi Sekunder adrenocortical hypofungsi
Primer acute adrenocortical insuffisiency Waterhouse-Friderichsen Syndrome Cause : meningococcus DIC circulatory collaps Primer chronic adrenocortical insufficiency Addisons disease Caused by chronic destructive proses adrenal cortex Tbc, sarcoidosis, cancer Autoimmune disease Hyperfungsi adrenal cortex Cushing syndrome Conns syndrome Adrenal virilism and congenital adrenal hyperplasia (CAH) Cushing Syndrome Pathogenesis: Hipophyse Adrenal Ectopic Iatrogenic Conns syndrome Etiologi: Adenoma producing aldosteron Idiopatic
feokromositoma Jarang Katekolamin dan hipertensi 25% di medula, 75% ekstra adrenal Sporadik 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 Von reklinghausen neurofibromatosis, schwanoma, meningioma, glioma, F Sturger weber hemangioma kavernosum n trigeminus, F
Tumor 10% 10% bilateral 10% ekstraadrenal 10% anak 10% malignancy Morfologi zeballen Klinis Hipertensi Gagal jantung Infark miokard Laboratorium katekolamin urin dan plasma CT, MRI, USG Neuroblastoma < 5 tahun Sel-sel bentuk bulat kecil dengan latarbelakang neurofibriler Pseudoroette homer wright Diferensiasi sel ganglion ganglioneuroblastoma-ganglioneuroma Metastasis