Apr 25, 2021
Medical education, we are told, that is aimed at our patients should be written at a sixth-grade level if we want to have a majority of our patients understand what we are trying to tell them. Many, many people do not read or understand material aimed higher than a sixth-grade level, nor do they want or have time to, so to capture our patient’s attention and ability to understand we should aim no higher.
I have heard this advice many times but, to be honest, I never knew what that meant, to write at a certain grade level, nor how to achieve it.
What does it mean to read and write at the sixth-grade level?
There are a number of ways to determine what grade level a certain piece of writing is. I am going to highlight two of them. Most of the ways to calculate the reading level is to calculate based on sentence length, word complexity, and paragraph length.
THE ADRENAL GLAND
The adrenal glands are hormone producing glands. You have two adrenal glands, one on each side of the body above each kidney. The adrenal glands are about two inches long, and inch wide and half an inch thick. The glands are a deep yellow color.
The adrenal glands are surrounded fat which also surrounds the kidneys. A thin layer of fat separates the adrenal glands from the kidneys.
Each adrenal gland is made up of two parts, an outer layer called the cortex, and an inner core called the medulla.
The adrenal glands produce several different hormones.
Adrenaline is made by the inner portion of the adrenal gland. Adrenaline is released during times of stress. During times of danger adrenaline increases blood pressure and heart rate, breathing and causes your blood vessels to narrow as a way to prepare your body to either run away from the danger or to stay and fight.
The adrenal cortex has three layers. Each layer makes its own hormone.
The first layer of the adrenal cortex produces a hormone called aldosterone that helps regulate of blood pressure and salt levels in the body.
The second layer of the adrenal cortex makes a hormone called cortisol that helps regulate metabolism and the immune system.
The innermost layer of the cortex makes a hormone that gets converted to sex hormones in other parts of the body.
The adrenal gland can be seen on CT and MRI scans. A mass or tumor as an incidental finding can be seen in up to 3-5% of CT scans. Many of those unexpected small tumors are not functional and do not need to be treated.
There are a number of diseases involve dysfunction of the adrenal gland.
Insufficient production of adrenal hormones is called Addison's disease. Symptoms of Addison’s disease include hyperpigmentation of the skin, sudden pain in the legs, lower back, or abdomen, vomiting and diarrhea, low blood pressure, low blood sugar, tiredness, confusion, low salt levels in the blood and fever. A famous patient who suffered from Addison’s disease was the late President John F. Kennedy.
Overproduction of cortisol within the body or taking prednisone for a long period of time leads to Cushing's syndrome. Cushing’s syndrome produces a wide variety of signs and symptoms which include obesity, diabetes, increased blood pressure, excessive body hair, poor bone health, depression, and stretch marks in the skin.
A variety of non-cancerous tumors are found in the adrenal gland and are commonly found on x-rays. The most common finding is a tumor that does not produce any hormones.
A common functioning tumor that produces too much aldosterone is called a hyperaldosteronoma, which causes abnormalities of blood pressure and salt levels in the blood.
A tumor that produces too much adrenaline is called a pheochromocytoma. Common signs of a pheochromocytoma include a sudden high blood pressure, sweating and a rapid heart rate.
Cancer of the adrenal gland is uncommon.