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Published in Samar Razaq, Difficult Cases in Primary Care, 2021
Congenital adrenal hyperplasia is a group of disorders inherited in an autosomal recessive pattern. They are characterised by abnormal adrenal corticosteroid production due to a deficiency in one of five enzymes involved in their production. A 21-hydroxylase deficiency accounts for the commonest form of CAH, leading to cortisol deficiency with or without aldosterone deficiency. The resultant increase in adrenocorticotrophic hormone stimulates hyperplasia of the adrenal glands. Since cortisol production is defective, its precursors, in the form of adrenal androgens, poor out into the bloodstream causing virilisation in the child. In girls this may cause enlargement of the clitoris to the point that she may be mistaken for a normal male. Internal organ development is normal. Diagnosis in boys is usually in early childhood, as there is abnormal enlargement of the penis and rapid growth. In the more severe form of CAH (salt-wasting form), the zona glomerulosa of the kidney is also involved, resulting in loss of urinary sodium. The child will present with dehydration, vomiting and shock.
Paper 2
Published in Aalia Khan, Ramsey Jabbour, Almas Rehman, nMRCGP Applied Knowledge Test Study Guide, 2021
Aalia Khan, Ramsey Jabbour, Almas Rehman
Phaeochromocytoma is a noradrenaline-secreting tumour of the adrenal glands with a peak incidence in the 30- to 40-year age group. Acute symptoms include tachycardia, anxiety, sweating and headaches. Hypertension which is unresponsive to medication is the usual presenting feature.
Endocrine Therapies
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
As estrogens and androgens play a role in the growth of certain tumor types (e.g., hormone-responsive breast and prostate, respectively), inhibiting their production with an agent such as aminoglutethimide can reduce growth rate. Furthermore, tumors of the adrenal glands are usually associated with excess steroid production which can ultimately cause Cushing’s syndrome. Thus, aminoglutethimide suppresses the production of these steroids, and so is used in this context to decrease symptoms.
Duplicated adrenal veins in primary aldosteronism misdiagnosed with ectopic aldosteronoma due to apparent bilateral aldosterone suppression
Published in Blood Pressure, 2023
Jingwen Yu, Cunxia Fan, Weiping Wei, Haiwei Liu, Tuanyu Fang, Huibiao Quan, Kaining Chen, Yuhai Zhang
Since the nodule from the right side is located quite close to the liver, with the presented apparent bilateral aldosterone suppression, we initially considered the diagnosis to be an ectopic aldosteronoma. An ectopic (accessory) adrenocortical tissue or adrenal rests may contribute to the appearance of apparent bilateral aldosterone suppression. The most common ectopic site is in close proximity to the adrenal glands and along the path of descent or migration of the gonads. The ectopic adrenal glands atrophy as we get older which makes them very difficult to find in adults [8]. The ectopic adrenocortical tissue can develop into hyperplasia or adenoma as normal adrenal glands do. Conn’s syndrome, Cushing’s syndrome, and virilization occur when the ectopic tissue secrets aldosterone, cortisol, and androgen [9]. Adrenal Rest tumours are rarely located in the liver [10]. Radiological findings are usually described as a low-density roundish lesion with a regular border, nourished by the hepatic arteries [11,12].
Curcumin analogues exert potent inhibition on human and rat gonadal 3β-hydroxysteroid dehydrogenases as potential therapeutic agents: structure-activity relationship and in silico docking
Published in Journal of Enzyme Inhibition and Medicinal Chemistry, 2023
Xinyi Qiao, Lei Ye, Jialin Lu, Chengshuang Pan, Qianjin Fei, Yang Zhu, Huitao Li, Han Lin, Ren-shan Ge, Yiyan Wang
Cushing’s syndrome (hypercorticism) is characterised with massive cortisol secretion, which may be because h3β-HSD2 and r3β-HSD1 in adrenal glands were upregulated36,37. Cushing’s syndrome is accompanied with obesity, hypertension, osteoporosis, and type II diabetes38,39 and women’s PCOS is also a metabolic disease, which is characterised by excessive androgen secretion (hyperandrogenism), accompanied by insulin resistance, and polycystic ovary due to increased expression of 3β-HSD240. Although trilostane is a moderate 3β-HSD2 inhibitor and was once used to treat Cushing’s syndrome41. Due to different efficacy, it was withdrawn for human use in the United States in the 1990s. However, it was approved for treating Cushing’s syndrome in pets such as dogs and cats11,12. The identified potent h3β-HSD2 and r3β-HSD1 inhibitors of curcumin analogues such as DMC and BDMC may be potential food additives for therapeutic purposes and further preclinical studies are needed.
Management of adreno-cortical adenomas using microwave ablation: study of the effects of the fat tissue
Published in International Journal of Hyperthermia, 2022
Anna Bottiglieri, Martin O’Halloran, Giuseppe Ruvio, Laura Farina
Figure 2 shows a three-dimensional (3 D) model representing a pyramidal-shaped adrenal gland and the position of the gland on the top of the kidney. First, a pyramidal shell is designed within a three dimensional (3 D) full-wave electromagnetic software (CST MWS Suite 2018, Darmstadt, Germany). The shell is scaled to reproduce the dimensions of the medulla (inner shell) and the cortex (outer shell) [35]. The geometries representing the medulla and cortex are 13 mm and 24 mm in height, 40 mm and 60 mm in width, 20 mm and 30 mm in thickness. A fat capsule envelope the modeled adrenal tissues. The dimensions of the fat capsule are 45 mm in height, 108 mm in width and 30 mm in thickness. Finally, the model of the adrenal gland is arranged on top of a kidney model (49 mm in height, 32 mm in width and 33 mm in thickness) in agreement with [31]. Table 1 lists dielectric and thermal properties assigned to each tissue of the model. For the cortex and medulla, the dielectric properties at the operating frequency of 2.45 GHz reported in [30] are loaded into the material library of the CST MW Studio software. The dielectric properties of fat and kidney as well as the values related to the specific heat capacity, thermal conductivity and density of each material are acquired from the literature [36] and manually loaded into the material settings of the simulation software.