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F3 E4 Shea > Adrenal 1 > Flashcards

Adrenal 1 Flashcards

1
Q

What are the different parts of the adrenal gland and what does each section secrete?

A
  • Cortex (Can think “GFR–> ACE”)
    • outer: Zona Glomerulosa–> Aldosterone
    • middle: Zona Fasciculata –> Cortisol
    • Inner: Zona Reticularis –> Androgens/DHEA (think Estrogens for mnemonic)
  • Medulla–> Catecholamines (NE and Epi)
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2
Q

Aldosterone vs. cortisol: which is the mineralcorticoid? Which is the glucocorticoid?

A

Aldosterone= mineralcorticoid (“Al mines”)

Cortisol= Glucocorticoid

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3
Q

Which hormone is pulsatile and diurnal (AM>PM)?

A

Cortisol

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4
Q

What is cortisol under control of

A

ACTH

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5
Q

Which hormone?

  • Stress, trauma, etc cause release
  • Protects against hypoglycemia
  • Inhibits production of inflam. mediators
  • Suppression of immune response
  • Enhance vascular responsiveness to catecholamines
A

Cortisol

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6
Q

Which hormone?

  • Increases force/rate of contraction of heart
  • Vasoconstriction
  • Bronchodilation
  • Stimulation of lipolysis
  • Increase metabolic rate
  • pupil dilation
  • Inhibition of non-essential processes
A

Catecholamines (Epi/NE)

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7
Q

What is the long term response to stress? (

A
  • Mineralcorticoids (Aldosterone)
    • retention of Na and H20
    • Incr. blood volume and BP
  • Glucocorticoids (cortisol)
    • protein and fats converted to glucose
    • hyperglycemia
    • suppression of immune system
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8
Q

Is a stimulation test used to evaluate for hypo or hyperfunction? A suppression test?

A

Stimulation test= hypofunctioning

Suppression test= Hyperfunctioning

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9
Q

What is 24hr urinary free cortisol a test for

A

hypercortisolism

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10
Q

What does a serum cortisol value <3mg/dL on a serum total cortisol test very likely indicate?

A

Adrenal insufficiency

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11
Q

What is the main use of obtaining a plasma ACTH?

A

Adrenal insufficiency:

Differentiate primary (adrenal) vs secondary (pituitary) vs. tertiary (hypothalmic)

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12
Q

What does an ACTH stimulation test (using synthetic ACTH- Cosyntropin) evaluate for?

A

Differentiate source of adrenal insufficiency (cortisol deficiency)

(if no increase from baseline= adrenal insufficency)

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13
Q

What would an ACTH stimulation test show in adrenal insufficiency?

A

Subnormal cortisol level response

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14
Q

What does the following indicate on a Dexamethasone suppresion test:

No change in cortisol

A

= Excess cortisol production

(normal would be cortisol suppressed)

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15
Q

What are the 4 causes of Cushings syndrome? (hypercortisolism)

A
  • ACTH dependent (MC)
    • Pituitary adenoma (MC overall)–> cushings DISEASE
    • NET producing ACTH- small cell lung cancer, ovarian cancer
  • ACTH independent
    • Chronic glucocorticoid use (2nd MC)
    • Adrenocortical tumor (benign or malignant
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16
Q

What are the 2 MC causes of Cushings syndrome?

A
  1. Pituitary adenoma (MC overall, ACTH dependent)–> Cushings Disease
  2. Chronic glucocorticoid use (ACTH independent)
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17
Q

What is Cushings Sydrome?

A

Signs and symptoms due to prolonged exposure to excess cortisol

(Cushings Disease is de to Pituitary adenoma)

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18
Q

S/s of what?

  • Central obesity
  • moon face
  • cervical fat pad
  • Purple abdominal striae
  • Fatigue
  • Prox mm. weakness
  • HTN
  • Insulin resistance
A

Cushings syndrome

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19
Q

What 3 things may be seen in Cushings syndrome specifically in women

A

Hirsutism

Acne

Menstrual irregularities

20
Q

How do you dx Cushing syndrome?

(screening for Cushings- 3 tests, Differentiating causes- 1 test)

A
  • Clinical suspicion
  • Screening for Cushings:
    • 24hr urine cortisol: elevated
    • Midnight salivary cortisol levels: Incr. on 2 separate occations
    • Dexamethasone suppression test: NO CHANGE in cortisol levels
  • Differentiating causes:
    • Plasma ACTH:
      • < 6 (at any time)= adrenal tumor
      • > 80 @8am or >50 @4pm= Pituitary adenoma or ectopic production
21
Q

How do you Differentiate causes of Cushing Syndrome? (Adrenal tumor vs Pituitary adenoma vs ectopic)

A
  • Plasma ACTH
    • < 6 (@ any time)= adrenal tumor
    • >80 @8am or >50 @4pm= Pituitary adenoma or ectopic production
22
Q

What diagnostic study should be ordered if plasma ACTH indicates a pituitary tumor? An Ectopic ACTH producting tumor? An adrenal tumor?

A
  • Pituitary tumor- MRI
  • Ectopic ACTH producing tumor- CXR, pelvic U/S
  • Adrenal tumor- CT abdomen
23
Q

How do you tx Cushings syndrome if it is due to exogenou steroids?

A

taper to lowest dose

24
Q

How do you tx Cushings syndrome if it is due to pituitary adenoma?

A

transsphenoidal resection

25
Q

How do you tx Cushings syndrome if it is due to adrenal tumor

A

adrenalectomy

(Replacement therapy if this causes iatrogenic adrenal insufficiency)

26
Q

How do you medically treat Cushings if the patient is not a surgical candidate? (5)

A

1. Mitotane (permanent destruction of adrenal cells)

  1. Ketoconazole (inhib. prod of cortisol)
  2. Metyrapone (inhib. prod of cortisol)
  3. Mifepristone
  4. Pasireotide (inhib ACTH secretion)
27
Q

What is adrenal insufficency?

A

Inadequate production of adrenal hormones–> dysfunction/absence of adrenal cortices

28
Q

What is the MCC of Adrenal insufficiency in the US?

A

Addisons disease (autoimmune cortical destruction)

(this is a primary cause of adrenal insufficiency)

29
Q

What is the MCC of adrenal insufficiency worldwide

A

_TB (_primary adrenal insufficiency)

30
Q

What is the MC secondary cause of adrenal insufficiency

A

Long term exogenous steroids

(–> suppression of HPA axis–> abrupt withdrawal–> Addisons crisis)

31
Q

Hallmark tetrad of what?

  • Weakness/fatigue
  • weight loss/anorexia
  • hyperpigmentation (of non-sun exposed areas)
  • orthostatic hypotension
A

Adrenal insufficiency

(Hyperpigmentation specifically for Addisons)

32
Q

Adrenal insufficiency:

The following are s/s of deficiency of which hormone?

  • weakness/fatigue
  • hypoglycemia
  • wt loss/anorexia
  • N/V, abd pain
A
  • Glucocorticoid deficiency
33
Q

Adrenal insufficiency:

The following are s/s of deficiency of which hormone?

  • Na wasting (hyponatremia, salt craving)
  • Hypovolemia
  • orthostatic hypotension
  • hyperkalemia
  • mild metabolic acidosis
A

Mineralcorticoid deficiency

34
Q

Adrenal insufficiency:

The following are s/s of deficiency of which hormone?

  • Loss of axillary and pubic hair
  • amenorrhea
A

Adrenal androgen deficiency in females

35
Q

What causes Addisons crisis?

A

Extremely low cortisol!

Triggers= stress (infection, trauma, sx)

36
Q

T/F: Addison’s Crisis can be treated on an outpatient basis

A

FALSE.

This is a MEDICAL EMERGENCY

37
Q

Addisons crisis is MC in what?

A

primary adrenal insufficiency

38
Q

S/s of what?

  • SUDDEN ONSET:
  • hypotension
  • acute abd/back pain
  • N/V/D
  • Fever
  • dehydration
  • AMS
A

Addison’s Crisis

39
Q

How do you tx Addison’s crisis? (4)

A

MEDICAL EMERGENCY

  1. IV hydrocortisone and fludrocortisone
  2. Correct electrolyte abnormalities
  3. 50% dextrose
  4. Volume resusitation
40
Q

How do you dx Arenal insufficiency? (7)

A
  1. CMP: hyperkalemia, hyponatremia, fasting hypoglycemia
  2. Eosinophilia
  3. +/- anti-adrenal antibodies
  4. AM plasma cortisol < 3= adrenal insuff.
  5. Plasma ACTH level ( >80 @8am or >50 @4pm)= pituitary adenoma or ectopic)
  6. ACTH stimulation test: No change in cortisol= adrenal insufficiency
  7. CT of abd/pelvis, MRI of pituitary
41
Q

What are the 3 causes of secondary adrenal insufficiency

A
  1. Long term exogenous steroids (MC)
  2. Hypopituitarism
  3. Meds (decr. corticosteroid levels): phenytoin, opiates, rifampin, ketoconazole
42
Q

Compare Addisons disease (primary adrenal insufficiency) and hypopituitarism in regards to cortisol and ACTH

A

Addisons: decr. Cortisol and incr. ACTH

Hypopituitarism: Decr. cortisol and decr. ACTH

43
Q

How do you treat primary adrenal insufficiency (Addisons disease)?

A

Hydrocortisone (glucocorticoid)

+

Fludrocortisone (mineralcorticoid)

44
Q

How do you treat secondary/tertiary adrenal insufficiency?

A

Hydrocortisone ONLY

(Dont need fludrocortisone b/c RAAS manages aldosterone)

45
Q

What might you give women with adrenal insufficiency

A

DHEA

F3 E4 Shea (12 decks)

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