6 - Adrenal Disease Flashcards
what is made in the layers of the adrenal cortex?
glomerularis - aldosterone
fasciculata - cortisol
reticularis - cortisol (less), DHEA, androstenedione
Addison’s dz =
primary adrenal insufficiency
MCC addison’s dz
autoimmune
MC hemorrhagic cause of addison’s dz
antiphospholipid syndrome
what kinds of infections can cause addison’s?
TB, fungal, HIV/CMV
causes of secondary adrenal insufficiency
pituitary tumor hypophysectomy surgery/radiation to pituitary area Sheehan's syndrome infection
causes of tertiary adrenal insufficiency
stopping glucocorticoid tx head trauma / TBI sarcoidosis Hand-Schuller-Christian dz drugs that inhib CRH secretion (morphine, fentanyl)
sx of adrenal crisis
fever, postural hypotension, shock, weakness, muscle/joint/abd pain, AMS
sx of chronic adrenal insufficiency
weakness/fatigue N/V/D anorexia / wt loss depression psychoses musc/joint/abd pain hyperpigmentation orthostatic hypotension
lab findings in adrenal insufficiency
hyponatremia and hyperkalemia elevated BUN and Cr > volume contraction hypoglycemia after prolonged fasting anemia relative lymphocytosis and absolute eosinophilia
gold standard test to dx adrenal insufficiency
ACTH stimulation test
which adrenal insufficiency pts will have small adrenal glands on imaging?
idiopathic or autoimmune pts
drugs that cause primary aldosterone deficiency
heparin, ACEIs, ARBs
causes of secondary aldosterone def
renal disease (dec renin)
beta blockers
cyclosporine
NSAIDs
