Lecture 20 - Clinical Aspcts of Adrenal Disorders

Lecture 20: 11/5 IV. Clinical aspects of adrenal disorders B. GC Hyposecretion Addison's Disease destruction of the adrenal cortex gradual, from autoimmune diseases, from viral infection low GCs destruction of Zona fasciculata, mas symptoms of ↓ GC elevated ACTH, due is feedback hyperpigmentation cause of high ACTH C. Aldosterone disorders Hyperaldosteronism adrenal adenoma (primary) like Cushings (↑ uido GC) blockage or narrowing of the renal artery (secondary) control of aldosterone secretion from AAS (renal) Restricts blood to afferent arteriole, false impression that ↓ BP activates the JG cells in afferent arterioles to release renin - RAS ↓ K⁺ ↑ Na⁺ muscle weakness thirst, urination, hypertension D. Congenital Adrenal Hyperplasia: spons multis 1. Causes 90-95% of cases due to 21-hydroxylase deficiency gene sue congenital) P450c (PGC) pragestone concert, ↓ GC 2. Symptoms masculinization of female genitalia prior to birth, GC will TACTH, stimulate 2.8 (adrenal cortex), which produces weak androgens and that will cause masculinized genitalia Short stature, premature closure of epiphyseal plate fartage sections on lang bones salt balance problems no sidesterane (need GC to maxe it) PB Aldosterone 21-hydroxylase deficiency Region Incidence smaller pop marry incestually. Alaskan Yupika 1:300 USA 1:7,000 Finland 1:123,000F&M(-) Development of reproductive system Brain (hypothalamus) Pituitary Gland Ju LILFSH Ovaries/Testes narmaisxpected F (+) F&M(-) pathway happens in bett mains farmales, F&M(-) Brain kisspeptin (ARC) (hypothalamus) Pituitary Gland Ovaries/Testes (arcuate) (AVPV) Sexspecte ans long-loop feedback Gonadal staroids (E2, P. T) HPG axis HPG axis long-loop feodback Gonadal steroids EZ P. T) F&M(-) A. Sex Determination strictly genete Sex Covaries/testes) is determined by genes mammals Mate (neteragametic) XY - Female (namagametic) XX SRY gene on the Y chromosome genetic basis for sex determination Covaries or testes) XY nas 58Y (testis determining factor) testis XX no SRY (default) ovary B. Sex differentiation-cred Differentiation of -reproductive tract external genitalia according to genetic sex-regulated by humanes Differentiation of reproductive. fract @sexually indifferent ducts Estradial extris positive feedback and the hypothalamis EZ1-RH and then TEZ females (puter feednack) female Donads praduce the harmones Actuis Inhibin wut freators another way 754 is contistled in addition to GnRH (top bottom sang) hardzy loe shudy multe famans ARC. POA Section of tapinatulate OnRH Kisspephin comes fam ARC (arcuate) and AVPV (astarosene geticule) Risspeptin was stuting for gratis of conser "tay" puberty Mesonephric Mbule Wolffian duct Gonad Müllerian duct Male reproductive tract vas deferens seminal vesicle -epididymis Female reproductive tract oviduct uterus vagina b. differentiation of the male duct Testis Testosterone Müllerian Inhibiting Substance (MIS). Hoiffian dust maintained Müllerian duct degenerates C.differentiation of the female cluct (XX) No testis No testosterone NO MIS- Wolffion duct degenerates Müllerian duct maintained 2. Differentiation of the external genetalia a. differentiation of the male external genitalia Testis festosterone- DHT (needs to be converted to strongest farm la form) b. differentiation of the female external genitalia No testis No testosterone no DHT No DHT =default *DHT controls external genitalia -androgens (T) can do the job too