Adrenal Disease Emory University原发性肾上腺疾病埃默里大学ppt课件.ppt

Primary adrenal insufficiency:Evaluation Random cortisol in ill patient 20 mcg/dL reassuring Adrenal Autoantibodies ACA—adrenal cortex antibody Anti-21-OH-hydroxylase antibody 乙方有义务提供相应的执业资格证、执业印章等配合甲方工程招投标、承担的工程项目报建及建设施工过程中各类手续办理。 Primary Adrenal Disease Briana Patterson, M.D. Fellow, Pediatric Endocrinology Emory University School of Medicine Objectives Normal adrenal physiology Common causes of primary adrenal insufficiency Evaluation of suspected adrenal insufficiency Acute and chronic management issues Normal Adrenals Adrenal Cortex Zona Glomerulosa: Mineralocorticoids Zona Fasiculata: Glucocorticoids Zona Reticularis: Androgens Medulla Adrenal Histology Capsule Glomerulosa Fasiculata Reticularis Medulla Adrenal physiology 1:HPA axis Adrenal physiology 2:Renin-angiotensin system Steroid Biosynthesis ACTH Cholesterol Progesterone Pregnenolone Corticosterone DOC 18-OH-Corticosterone Aldosterone StAR, 20,22-desmolase 3βHSD 21-hydroxylase 11β-hydroxylase 18-hydroxylase 18-oxidase 17-OH-Pregnenolone 17-OH-Progesterone DHEA Androstenedione 17α-hydroxylase 17α-hydroxylase 3βHSD Testosterone Estrone Estradiol aromatase aromatase 17βHSD 17βHSD 3βHSD 17,20-lyase 17,20-lyase 11-deoxycortisol Cortisol 21-hydroxylase 11β-hydroxylase Primary adrenal insufficiency:Etiologies Acquired Autoimmune AIDS Tuberculosis Bilateral injury Hemorrhage Necrosis Metastasis Idiopathic Congenital Congenital adrenal hyperplasia Wolman disease Adrenal hypoplasia congenita Allgrove syndrome (AAA) Syndromes Adrenoleukodystrophy Kearns-Sayre Autoimmune polyglandular syndrome 1 (APS1) APS2 Primary adrenal insufficiency:Etiologies Acquired Autoimmune AIDS Tuberculosis Bilateral injury Hemorrhage Necrosis Metastasis Idiopathic Tuberculosis Adrenal Hemorrhage:Meningiococcemia Addison’s Disease 1st described in 1855 by Dr. Thomas Addison Refers to acquired primary adrenal insufficiency Does not confer specific etiology Usually autoimmune (~80%) Addison’s Disease Addison’s Normal Prima