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Adrenal Gland

Dr. Muhartono, M.Kes, Sp.PA


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

Adrenogenital Syndrome

Males precocious puberty
females virilism
newborns congenital cortical hyperplasia
enymze defect (21-hydroxylase deficiency)
adults adrenal cortical adenomas and
carcinomas
Adrenal lesions
Adenoma
Lesi kuning jingga
Cyst
Karsinoma kortek adrenal
Sangat ganas
Diff baik-anaplastik
Invasi PD, metastasis kgb, paru
Adrenal medula
Pheochrocytoma MEN
Neuroblastoma
Ganglioneuroma

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