Case 1 : Addison disease

Case 1 : Addison disease

A 12-year-old girl presented with vague abdominal discomfort for 6 months. She had noticed occasional diarrhoea but had not passed any blood. She admitted to weight loss (6kg) and anorexia. On examination, she was obviously pigmented, although she thought this was sun induced; however, her buccal mucosa and gums were also brown. There were no other physical signs.

She had a low cortisol level and her response to the adrenocorticotrophic hormone in a Synacthen test was poor. A diagnosis of adrenal cortical failure was made. X-ray of her abdomen showed no calcified areas in either adrenal gland, and her serum contained antibodies to adrenal cortex, consistent with a diagnosis of Addison's disease due to autoimmune adrenalitis. Her serum also contained antibodies to pancreatic islet cells and thyroid microsomes. In view of her young age at presentation and these serum antibodies, she will be followed at yearly intervals to see if she develops other autoimmune endocrinopathies.

from: www.immunologyclinic.com

Adrenal gland

• found at the level of T12
• divided into 2 area : adrenal cortex and adrenal medulla

Adrenal medulla

• form the core of adrenal gland
• made up by chromaffin cells that produce

1. catecholamine : adrenaline and noradrenaline
2. dopamine

Adrenal cortex

• form the outer layer of adrenal gland
• consist of 3 layers : zona glomerulosa ,zona fasciculata, zona reticularis
• zona glomerulosa :
  

1. the outermost layer of the cortex
2. produce mineralocorticoids mainly aldosterone

• zona fasciculata:

1. middle layer
   
2. produce glucocorticoids mainly cortisol

• zona reticularis

1. innermost layer
2. produce small number of androgens
   

atrial pressure

atrial pressure increases when :

• a wave : atrial contraction
• c wave: as ventricle contracts - due probably to bulging of AV valve into atria
• v wave: increases slowly at atrium fills with blood from periphery

atrial pressure reduces when :

• x descent: atrium relaxes and tricuspid valve is pulled downwards
• y descent : tricuspid valve opens and blood flows into right ventricle