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Renal and Endocrine > 3.2.2 Adrenal Cortex and Medulla Clinical Cases II > Flashcards

3.2.2 Adrenal Cortex and Medulla Clinical Cases II Flashcards

1
Q

Where to look for pigmentation in Addison dz

A
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2
Q

This is a great summary chart. Fill it out

A
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3
Q

What are two treatment options for the treatment of hyperaldesteronism?

A

Surgical ressection

Aldosterone receptor antagonists (spironolactone/eplerenone)

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4
Q

What are some treatment methods for the various presentations of CAH 21 OH deficiency?

A

GC for classic

No GC for asymptomatic

Mineralcorticoids for salt wasting

GC can help hirsutism in non-classic CAH adults

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5
Q

What are some symptoms of chronic adrenal insuffiency?

A

Weakness, fatigue, anorexia, nausea, abdominal pain, diarrhea, occasional orthostatic dizzineiness/hypotension, weight loss

Primary: salt cravings, pigmentation, and hyperkalemia

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6
Q

Primary adrenal insufficiency due to destruction of adrenal glands

A

Addison’s Dz

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7
Q

When should you consider adrenalectomy?

A

Size greater than 4 cm

Evidence of growth

Suspicious findings from CT

Evidence of hormonal secretion

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8
Q

What are the three common features of polyglandular autoimmune syndrome Type I (most common cause of primary AI)?

A

Hypoparathyroidism, onset childhood AI, Mucocutaneous candidiasis

(HAM)

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9
Q

What are the aldosterone and renin levels in secondary hyperaldosteronism?

A

Aldosterone: High

Renin: High

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10
Q

Most commonly are clinically non-hypersecreting benign tumors, an adrenal mass >1 cm discovered serendipitously

A

Adrenal incidentaloma

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11
Q

What precursor is elevated due to a 21-hydroxylase deficiency?

A

17-OH pregesterone

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12
Q

Describe the ACTH levels in primary/secondary adrenal insuffiency?

A

Primary: Elevated ACTH

Secondary: Normal or low ACTH

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13
Q

If you positively screen a patient, what are the next steps?

A

Adrenal imaging and adrenal vein sampling

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14
Q

What are some of the primary AI causes worldwide?

A

TB, fungi, metastatic cancer, AIDS, waterhouse-friederichson syndrome

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15
Q

Most common cause of secondary AI?

A

adrenal suppression after exogenous GC

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16
Q

What are some common features of polyglandular autoimmune syndrome type II?

A

Onset young adults, autoimmune thyroid dz, type 1 diabetes

17
Q

What are the clinical features in hyperaldosteronism? Who is most commonly effected?

A

HTN and hypokalemia

Middle-aged women

18
Q

What some of the common clinical features in 21 OH deficiency?

A

Females: ambiguous genitalia (large clit, fused labia, comon urogenital sinus)

Boys: No overt signs - hyperpigmentation and penile enlargement

Untreated - rapid somatic growth, advanced bone age, premature epiphyseal fusion and short stature

19
Q

Have you ever seen the human version of Lady and The Tramp?

A

Now you have

20
Q

What is used to diagnose CAH prenatally?

A

Molecular analysis of CYP21A2 gene

21
Q

What are the aldosterone and renin levels in primary aldosterone excess?

A

Aldosterone: High, duh!!!!

Renin: Low

22
Q

Tests to diagnose adrenal sufficiency

A

Acute setting: serum cortisol

Check at 8 am cortisol if borderline

ACTH stimulation test

23
Q

If you incidentally find an adrenal mass, what additional tests would you order?

A

Size matters: if greater than 4 cm, could be malignant

24
Q

What might be going on in the hypothalmamic-pituitary system in secondary adrenal insufficiency?

A

Relative or complete ACTH deficiency

25
Q

What are some of the clinical features of Addison’s dz?

A
26
Q

What conditions is a group of AR disorders resulting from a deficiency of an enzyme (90% are 21 hydroxylase def) required for the synthesis of cortisol in the adrenal cortex), which leads to excessive sex hormone?

A

Congenital adrenal hyperplasia

27
Q

Who should be screened for hyperaldosteronism?

A

HTN and hypokalemia

HTN resistant to Rx

Incidental adrenal nodule on imaging

28
Q

What is the biochemical testing for Cushing’s Syndrome?

A

1 mg dexamathasome suppression test

29
Q

How do we screen for hyperaldosteronism?

A

Plasma aldosterone: plasma renin ratio in AM

Ratio >20 ng/dl and plasma aldo > 15 ng/dl w/ suppressed renin

Confirmatory test: salt loading and saline infusion test

30
Q

What are three conditions that can lead to primary aldosterone excess?

A

Adrenocortical adenoma (Conn’s syndrome), Bilateral idiopathic hyperaldosteronism (IHA), Adrenal carcinoma

These are in order of most to least common.

31
Q
A

D. Hyperkalemia

32
Q

Treatment of AI?

A

Replace GC w/ hydrocortisone

Replace MC w/ Fludrocortisone (PRIMARY ONLY)

Renal and Endocrine (46 decks)

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