Adrenal disease

Krieger DT (1979) Human plasma immunoreactive lipotropin and adrenocorticotropin in normal subjects and in patients with pituitary-adrenal disease. J din Endocrinol Metab 48 566-571... 

Osteoporosis occurs when bone mass is less than one would expect for the average person of a specific age. Osteoporosis can have many causes. The reduction of the female hormone estrogen after menopause is the most common. Persons who have increased thyroid hormone (hyperthyroid) can become osteoporotic. Patients receiving steroids for long periods of time, either as medication or because of adrenal disease (Cushing s disease) are also at risk. 

These agents have use in diagnosis of adrenal disease and in controlling excessive production of corticosteroids, e.g. by corticotropin producing tumours of the pituitary (Cushing s syndrome) or by adrenocortical adenoma or carcinoma where the cause cannot be removed. They must be used with special care since they can precipitate acute adrenal insufficiency. Some members inhibit other steroid synthesis. 

Metabolic disorders such as hypoglycemia, adrenal disease, vitamin deficiencies, electrolyte imbalances Organ diseases such as hepatic encephalopathy Pernicious anemia... 

Cushing s Ectopic Adrenal disease ACTH disease (n = 203) syndrome (n = 11) (n = 17)... 

The adrenal cortex plays a key role in regulating intermediary metabolism, fluid and electrolyte balance, and the response to stress. Molecular analyses of specific disorders resulting from either the diminished or enhanced produc-tion/action of corticosteroids have led to the identification of a number of genes that play key roles in adrenal function and corticosteroid action. These genes provide potential targets for novel therapies that may revolutionize our approaches to these rare adrenal diseases. In addition, understanding the molecular causes of these diseases has provided important insights into basic adrenal functions that may translate into improved therapy of more common disorders such as hypertension and obesity. 

REPLACEMENT THERAPY Adrenal insufficiency can result from structural or functional lesions of the adrenal cortex (primary adrenal insufficiency or Addison s disease) or from structural or functional lesions of the anterior pituitary or hypothalamus (secondary adrenal insufficiency). In developed countries, primary adrenal insufficiency most frequently is secondary to autoimmune adrenal disease, whereas tuberculous adrenalitis is the most frequent etiology in underdeveloped countries. Other causes include adrenalectomy, bilateral adrenal hemorrhage, neoplastic infiltration of the adrenal glands, acquired immunodeficiency syndrome, inherited disorders of the steroidogenic enzymes, and X-Unked adrenoleukodystrophy. Secondary adrenal insufficiency resulting from pituitary or hypothalamic dysfunction generally presents in a more insidious manner than does the primary disorder, probably because mineralocorticoid biosynthesis is preserved. 

Kloos et al. (Kloos et al. 1997) reported that adrenal incidentalomas are found in up to 5% of patients having CT for other reasons. In the series reported here, however, none of the patients had non-adenomatous adrenal disease, so none of the patients had benefit of this diagnosis. 

Cortisone is a hormone produced by the cortex of the adrenal glands. As with other adrenal corticoid steroids, administration of cortisone leads to an increased deposition of liver glycogen. Tt can remove features of rheumatoid arthritis, but does not check the underlying disease it is used in various diseases of the eye, and is an antiallergic and anlifibroplastic agent. 

Unfortunately steroids merely suppress the inflammation while the underlying cause of the disease remains. Another serious concern about steroids is that of toxicity. The abmpt withdrawal of glucocorticoid steroids results in acute adrenal insufficiency. Long term use may induce osteoporosis, peptidic ulcers, the retention of fluid, or an increased susceptibiUty to infections. Because of these problems, steroids are rarely the first line of treatment for any inflammatory condition, and their use in rheumatoid arthritis begins after more conservative therapies have failed. 

The adrenergic system is an essential regulator that increases cardiovascular and metabolic capacity during situations ofstress, exercise, and disease. Nerve cells in the central and peripheral nervous system synthesize and secrete the neurotransmitters noradrenaline and adrenaline. In the peripheral nervous system, noradrenaline and adrenaline are released from two different sites noradrenaline is the principal neurotransmitter of sympathetic neurons that innervate many organs and tissues. In contrast, adrenaline, and to a lesser degree noradrenaline, is produced and secreted from the adrenal gland into the circulation (Fig. 1). Thus, the actions of noradrenaline are mostly restricted to the sites of release from sympathetic nerves, whereas adrenaline acts as a hormone to stimulate many different cells via the blood stream. 

Historically the only melanocortin peptide to be used clinically is the parent hormone from which all these peptides are derived from namely ACTH (see above). It has also been used in the treatment infantile spasms for epilepsy, where it is administered as an intramuscular injection only over a 2-12 weeks period. Obvious side effects include weight gain, puffy face, high blood pressure and an increased risk of infection and should never be administered to patients with diabetics, renal or heart failure. ACTH is also used as a stimulation test to measure adrenal cortex activity, i.e. production of cortisol and is used to ascertain whether someone has Addison s disease. 

Once essential hypertension develops, management of this disorder becomes a lifetime task. When a direct cause of the hypertension can be identified, the condition is described as secondary hypertension. Among the known causes of secondary hypertension, kidney disease ranks first, with tumors or other abnormalities of the adrenal glands following. In malignant hypertension the diastolic pressure usually exceeds 130 mm Hg. In secondary hypertension,... 

Potassium is contraindicated in patients who are at risk for experiencing hyperkalemia, such as those with renal failure, oliguria, or azotemia (file presence of nitrogen-containing compounds in the blood), anuria, severe hemolytic reactions, untreated Addison s disease (see Chap. 50), acute dehydration, heat cramps, and any form of hyperkalemia Potassium is used cautiously in patients with renal impairment or adrenal insufficiency, heart disease, metabolic acidosis, or prolonged or severe diarrhea. Concurrent use of potassium with... 

Other Inflammatory Muscle Disorders Endocrine Myopathies Thyroid Disorders Adrenal Disorders Pituitary Disorders Parathyroid Disorders Pancreatic Disorders Drug-Induced and Toxic Myopathies Management of Muscle Disease... 

This is an acute, non-invasive infectious disease associated with the upper respiratory tract (Chapter 4). The incubation period is fiom 2 to 5 days although the disease remains communicable for up to 4 weeks. A low molecular weight toxin is produced which affects myocardium, nervous and adrenal tissues. Death results in 3-5% of infected children. Diphtheria immunization protects by stimulating the production of an antitoxin. This antitoxin will protect against the disease but not against infection of the respiratory... 

Ritchie, JC and Nemeroff, CB (1991) Stress, the hypothalamic-pituitary-adrenal axis and depression. In Stress, Neuropeptides and Systemic Disease (Eds McCubbin, JA, Kaufmann, PG and Nemeroff, CB), Academic Press, London, pp. 181-197. 

Lifelong glucocorticoid replacement therapy may be necessary for patients with adrenal insufficiency, and mineralocor-ticoid replacement therapy usually is required for those with Addison s disease. 

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