Continuing Education in Anaesthesia, Critical Care & Pain | Volume 5 Number 4 2005 © The Board of Management and Trustees of the British Journal of Anaesthesia [2005]. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Anaesthesia and adrenocortical disease
Division of Anaesthesia and Intensive Care, University Hospital, Nottingham, NG7 2UH
Division of Anaesthesia and Intensive Care, University Hospital, Nottingham, NG7 2UH
Tel: 01159 709229, Fax: 01159 700739, E-mail: j.hardman@nottingham.ac.uk (for correspondence)
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| Key points Adrenocortical disease results in disturbances of body water volume and electrolyte concentrations; intra-cellular electrolyte defects may be severe. Preoperative assessment is of crucial importance in identifying the endocrine disease process and the severity of its effects. Preoperative preparation involves correction of volume deficit and electrolyte disturbances, and replacement of deficient hormones. Cardiovascular disturbance and instability are particularly common and invasive cardiovascular monitoring should be considered. Postoperative mineralocorticoid and glucocorticoid supplementation should be considered in Addison's disease and in steroid-induced hypoadrenalism.
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Physiology |
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The adrenal glands lie on the superior aspect of the kidneys and consist of two endocrine organs: the inner adrenal medulla and the outer adrenal cortex. The adrenal cortex and medulla have distinct embryological origins. The medullary portion consists of chromaffin cells derived from the ectodermal cells of the neural crest. The cortex is of mesodermal origin.1 2 The adrenal glands are densely vascularized, the arterial blood supply reaching
Adrenal medulla
Adrenal cortex
Synthesis and release of glucocorticoids and mineralocorticoids
Actions of glucocorticoids
Regulation of glucocorticoid activity
Actions of mineralocorticoids
Regulation of aldosterone secretion
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Disorders of adrenocortical function |
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Hyperaldosteronism
Clinical features and investigations
Diagnosis
Treatment
Cushing's syndrome
Clinical features and investigations
Screening tests
Establishing the cause
Treatment
Adrenocortical insufficiency (Addison's disease)
Clinical features and investigations
Diagnosis
Treatment
Acute Addisonian crisis
Relative adrenal insufficiency in the critically ill
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Anaesthetic management |
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Conn's syndrome
Cushing's syndrome
Addison's disease