A & P Case Study on Addisons Disease

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  • Topic: Cortisol, Adrenal insufficiency, Aldosterone
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Unit 1 Case Study

Addison’s disease is from a result from damage to the adrenal cortex. These two

adrenal glands are located on top of the kidneys, where they are enclosed in a

fibrous capsule and a cushion of fat. . The have an outer portion, called the

cortex, which is a glandular tissue derived from embryonic mesoderm. The inner

portion called the medulla, which is more like a knot of nervous tissue than a gland

and it is part of the sympathetic nervous system. The adrenal cortex synthesizes

over two dozen steroid hormones called corticosteroids. The Adrenal medulla is part

of the autonomic nervous system. They are often referred to as the suprarenal

glands. That damage causes the cortex to produce less of their hormones

(corticosteroids) The 3 types of hormone secreted are the glucocorticoid hormone

(Cortisol) which maintain glucose control, decrease immune response and help the

body respond to stress. The mineralocorticoid hormones (aldosterone) regulates

sodium and potassium balance. The 3rd one is the sex hormones, androgen and

estrogen, which affect sexual development and sex drive. There are a few things that

may cause damage such as, the immune system mistakenly attacking the gland

(autoimmune disorder), infections such as tuberculosis, HIV or fungal infections.

Hemorrhage’s, tumors and use of blood thinning drugs are some other causes. Risk

factors for the autoimmune type of Addison’s disease include chronic thyroiditis,

dermatis herpetiforms, Graves’ disease, hypoparathyroidism, hypopituitarism,

myasthenia gravis, testicular dysfunction, type 1 diabetes and pernicious anemia.

Usually the destruction of the adrenal gland cortex is often gradual and the

symptoms are mild. Addison’s often goes undiagnosed until a sudden illness or accident occurs. The worsening of symptoms is called acute adrenal insufficiency

and can be life threatening. Let’s go back to the start of symptoms with Addison’s

disease. Here are a few, changes in heart rate and blood pressure, chronic diarrhea,

darkening of the skin (it becomes patchy), irregular menstruation, irritability,

paleness, extreme weakness, fatigue, loss of appetite, salt cravings, slow, sluggish

movements, weight loss, lesions on the buccal mucosa, nausea and vomiting. Acute

adrenal crisis have similar symptoms of course, however you will also see abdominal

pain, confusion, dizziness, headaches, joint pain, rapid heart rate, rapid

respirations, shaking chills, unusual and excessive sweating on face and/or palms.

And in severe cases coma and/or death. The initial diagnosis and decision to treat

are based on history, physical examination and lab findings. Lab tests such as

ACTH stimulation test, cortisol level, fasting blood sugar, serum potassium and

serum sodium. Tests may show an increase in potassium, low cortisol level, low

serum sodium. The Adrenal medullae normally secrete 80% epinephrine and 20%

norepinephrine. Sympathetic stimulation results in secretion. Epinephrine is the

more potent stimulator of metabolic activities, but norepinephrine has the greater

influence on peripheral vasoconstriction and blood pressure. The adrenal cortex

produces the 3 hormones listed above. Cortisol is produced from 2 hydroxylations of

17 alpha-hydroxyprogesterone. Cortisol is 90-93% protein bound. Glucocorticoids

are nonspecific cardiac stimulants that activate release of vasoactive substances. So

in the absence of corticosteroids, stress results in hypotension, shock and even death.

Glucocorticoids stimulate gluconeogenesis and decrease cellular glucose use,

mobilize amino acids and fatty acids, inhibit the effects of insulin, and give rise to

ketone bodies in metabolism, elevate RBC and platelet levels and exhibit anti-

inflammatory effects. Adrenal crisis occurs when the adrenal gland is...
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