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Endocrine Exam 1 > 12 - Adrenal Disorders > Flashcards

12 - Adrenal Disorders Flashcards

1
Q

Describe the adrenal glands

A
  • Tiny glands that sit on top of kidneys

- They make epi, norepi, aldosterone and cortisol

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2
Q

What do epi and norepi do?

A
  • Epinephrine – flight or fight. Increases HR, BP, dilates pupils, redirects blood to muscles
  • Norepinephrine – Increases BP
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3
Q

What does cortisol do?

A

Regulates BP, cardiac function, immune system, mood, insulin metabolism

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4
Q

What does aldosterone do?

A
  • Increase blood pressure
  • Controls water and sodium balance (water retention with low BP)
  • Helps kidneys keep sodium or get rid of potassium
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5
Q

What is secreted from the medulla of the adrenal gland?

A

Epinephrine and norepinephrine

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6
Q

What problems can arise from problems form the medulla or epinephrine/norepinephrine?

A
  • Pheocytocytoma

- Autonomic failure

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7
Q

What is secreted from the cortex of the adrenal gland?

A

Aldosterone and cortisol

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8
Q

What problems can arise from problems with the cortex/aldosterone?

A

Conn’s disease

Hypoaldosteronism

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9
Q

What problems can arise from problems with the cortex/cortisol?

A

Cushing’s disease

Addison’s disease

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10
Q

What is a pheochromocytoma?

A

Growth on the adrenal(s) leads to increased production of epi and NE

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11
Q

Why is a pheochromocytoma called a 10% tumor?

A

Called 10% tumor, because 10% are…

  • Malignant
  • 2 sided
  • In kids
  • Familial
  • Recur
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12
Q

Signs and symptoms of pheochromocytoma

A 
Rapid HR
High BP
Flushed
Anxiety
Pale

Need to surgically remove, radiation if malignant

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13
Q

What can cause autonomic failure?

A

A lack of epinephrine/norepinephrine

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14
Q

What is POTS?

A

Postural orthostatic tachycardic syndrome

  • A combination of symptoms from a variety of causes (viral, cancer, adrenals, etc.)
  • Patient will faint with SOB and fatigue
  • Orthostatic hypotension
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15
Q

How will you treat hypotension?

A

Hypotension medication

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16
Q

What is Addison’s disease?

A

Failure of adrenals to make enough cortisol (sometimes aldosterone can be low too)

It is rare –> 1/100,000

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17
Q

What causes Addison’s disease?

A
  • Lack of adrenal function/response to ACTH

- Lack of ACTH from the pituitary to act on the adrenals

18
Q

Which cause of Addison’s disease is primary? Which is secondary?

A

Primary

  • Lack of adrenal function/response
  • Most common
  • Mostly autoimmune

Secondary

  • Pituitary dysfunction leading to a lack of ACTH
  • Less common
19
Q

What signs and symptoms of Addison’s do you NEED to know?

A
  • Low glucose
  • Low sodium
  • High potassium

** NEED TO KNOW **

20
Q

What other symptoms will you see in Addison’s?

A
  • Weight loss
  • Decreased appetite
  • Fatigue
  • Low BP
  • Darkening of skin folds/membranes
  • Electrolyte imbalances
21
Q

What is an Addison’s crisis?

A

Not enough cortisol for the patient when they get sick or are in a stressful situation

  • This can be fatal
  • Abdominal, back, leg pain
  • Dehydration and hypotension
  • MAJOR low glucose, low sodium and high potassium
22
Q

How do you treat an Addison’s crisis?

A

STEROIDS

You can also pretreat an Addison’s patient with steroids before stress, such as a surgical case

23
Q

How do you test for Addison’s?

A

Give synthetic ACTH

  • If the cortisol level goes up, there is a problem in the pituitary gland producing ACTH
  • If the cortisol level does not go up, there is a problem with the adrenal gland
24
Q

What are the signs and symptoms of Cushing’s disease?

A
  • Trunk obesity
  • Buffalo hump
  • Hypertension
  • Hyperglycemia, hypernatremia, hypokalemia
  • Moon face
  • Purple stretch marks
  • Easy fractures
  • Sex hormone dysregulation
25
Q

What will long term Cushing’s lead to?

A
  • Obesity
  • Osteoporosis
  • Diabetes
  • Muscle weakness
  • Skin issues
26
Q

What causes Cushing’s?

A

Lots of things

  • Iatrogenic (we give them steroids for chronic problems so they develop Cushings)
  • Pituitary tumors
  • Ectopic tumors (islet cell, small cell, thyroid)
  • Adrenal problems
  • Familial causes
27
Q

What do we commonly use steroids for?

A
  • Autoimmune
  • Lung
  • Tendonitis
  • GI issues

Long term use can be an iatrogenic cause of Cushing’s disease

28
Q

What causes an overproduction of ACTH?

A
  • Over stimulation of adrenals, leading to too much cortisol
  • Pituitary tumors (adenomas) – called Cushing’s Disease. If large enough, can over-secrete other hormones (prolactin)
  • Ectopic ACTH from hormone secreting tumors (almost always lung cancers)
29
Q

How do you diagnose Cushing’s?

A
  • 24 hour urine – measure amount of cortisol made over 24 hours
  • Once you determine that this is high, chase down the source
30
Q

What do you do if cortisol is high?

A

Dexamethasone suppression test

When given steroids, body should adjust and decrease its own production – sees if the brain is responding and shutting down ACTH (remember control center is in the brain)

31
Q

How do you treat Cushing’s?

A
  • If they are on steroids, taper off the steroids
  • If they have a pituitary adenoma. surgery and maybe radiation
  • If they have ectopic production, remove tumor
  • If there is an adrenal lesion, surgically remove

Possibly treat with a new medicaiton - Signifor, which reuces cortisol in Cushing’s disease

32
Q

What do you give to a Cushing’s disease patient when they have a stressful event?

A

Like Addisons, Cushings may require stress dosing of steroids during illnesses, prior to surgery, etc…

Seems contradicting, but this is what works

33
Q

What is Conn’s disease?

A

Hyperaldosteronism

Overproduction of aldosterone
- Benign tumor (usual)
Bilateral adrenal hyperplasia

Either caused by a benign tumor or bilateral adrenal hyperplasia (not sure why)

34
Q

How common is Conn’s disease?

A

We used to think it was rare, but really it is not

35
Q

What can Conn’s be responsible for?

A

Resistant hypertension

Now we think 5-15% of hypertensive patients have adrenal hyperplasia or an adrenal mass and that is causing the high BP

There are many problems associated with high BP

36
Q

What is the treatment for Conn’s disease?

A

Treatment

  • Take out adrenal (if there is a mass) or
  • Spiranolactone (blocks aldosterone)
37
Q

What are the signs and symptoms of Conn’s disease?

A
  • Hypertension
  • Low potassium***

Hypertensive patient with low potassium –> NEED to consider Conn’s

38
Q

What glucose issue can be present in up to 20% of Conn’s disease patients?

A

Glucose intolerance – they have high glucose but it does not lead to diabetes

39
Q

What acid base issues may patients with Conns have?

A

Metabolic alkalosis

40
Q

Why will metabolic alkalosis develop?

A

Renal loss of hydrogen ions occurs when excess aldosterone (Conn’s syndrome) increases the activity of a sodium-hydrogen exchange protein in the kidney

Excess sodium increases extracellular volume and the loss of hydrogen ions creates a metabolic alkalosis. Later, the kidney responds through the aldosterone escape to excrete sodium and chloride in urine.

Endocrine Exam 1 (18 decks)

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