Adrenal

Question 1

What are the three zones of the adrenal cortex and what do each secrete

Answer 1

zona glomerulosa secretes mineralocorticoids (aldosterone)
zona fasciculata (glucocorticoids-cortisol)
zona reticularis (sex steroids)

Question 2

The ____ sampling of the two adrenal glands is different

Answer 2

venous (L goes through renal vein but R does not)

Question 3

Some causes of hypercortisolism

Answer 3

exogenous steroids, ACTH dependent pituitary, ACTH Cushing’s, adrenal adenoma

Question 4

Clinical manifestations of hyper cortisolism

Answer 4

(cushinggoid)

purple striae, moon facies, hyperglycemia, HTN, hyperpigmentation, thinning skin, change fat deposition

Question 5

Complications of hypercortisolism

Answer 5

CV risk, thromboemoli, muscle weak, more osteoporosis, neurophysical symptoms, increased morbidity/mortality

Question 6

What testing is done to diagnose Cushing’s

Answer 6

Dexamethasone suppression test, 24 hour urine free cortisol, late night salivary cortisol

Question 7

Treatment of hypercortisolism depends on ____

Answer 7

etiology

Question 8

If hypercortisolism etiology is pituitary ademona, what do you do

Answer 8

surgery, meds (cabergoline, pasireotide, mifepristone), irradiation, adrenalextomy

Question 9

If hypercortisolism etiology is ACTH what do you do

Answer 9

ID and remove tumor

Can’t? treat with adrenal enzyme inhibitors

Question 10

If hypercortisolism etiology is adrenal adenoma

Answer 10

unilateral adrenalectomy

Question 11

If hypercortisolism etiology is bilateral adrenal hyperplasia

Answer 11

get rid of adrenals, replace hormones or adrenal enzyme inhibtiors

Question 12

______ is 11 fold more likely in people with Celiac

Answer 12

autoimmune adrenalitis

Question 13

What are the two signs of autoimmune adrenalitis

Answer 13

21hydroxylase antibodies

Elevated ACTh may be early sign

Question 14

What are the two autoimmune adrenalitis and how do they manifest differently

Answer 14

Polyglandular autoimmune syndrome 1 and 2

1: hypoparathyroidism, mucocutaneous candidiasis, adrenal insufficiency, hypogonadism, malnutrition
2: hypogonadism, hypopituitarism, vitiligo/MG/RA/anti-phospholipid. NO hypoparathyroidism

Question 15

What are some causes of adrenal insufficiency

Answer 15

ID: TB, fungal, HIV, syphilis,
Adrenal infarct
hemorrhage infarct from meningitis. (Waterhouse friderichsen)
metastatic dz

Question 16

Secondary causes of adrenal insufficiency

Answer 16

pituitary mediated, hypophysitis

Question 17

Tertiary causes of adrenal insufficiency

Answer 17

hypothalamic, brain injury, med induced, chronic glucocorticoid

Question 18

Lab findings in adrenal insufficiency

Answer 18

hyponatremia, hyperkalemia, low cortisol, high ACTH

high ADH and decreased aldosterone

Question 19

What is the corticotropin stimulation test

Answer 19

give so much ACTH that adrenal gland has to release cortisol. In AI, it won’t release sufficient cortisol

Question 20

What are features of adrenal crisis

Answer 20

dehydration, hypotension, shock, N/V, abdominal pain, unexplained hypoglycemia, unexplained fever, hypo Na+, hyper K+, azotemia

Question 21

What do you give to treat adrenal crisis

Answer 21

steroids, mimicking endogenous cortisol rhythm

Question 22

What are signs and symptoms of adrenal cortex disorders

Answer 22

resistant HTN, Hypo K+, increased CV risk

Question 23

How to diagnose and treat adrenal cortex disorders

Answer 23

check renin/alodertone
confirmatory testing with salt loading
treat with mineralocorticoid antagonists (aldactone/eplerenone), unilateral or subtotal adrenalectomy

Question 24

The Thing that most commonly goes wrong in the adrenal gland is

Answer 24

21-α hydroxylase pathway

Question 25

Need to watch for _____ in someone who is sus for Cushing’s

Answer 25

exogenous steroid use

Question 26

Clinical manifestation of primary and secondary AI

Answer 26

tiredness, weakness, mental depression, anorexia, dizziness, N/V

Question 27

With an adrenal adenoma you must rule out

Answer 27

Cushing’s and pheochromocytoma

Question 28

Adrenocortical carcinoma main takeaway

Answer 28

everything’s goes back quickly (sick quickly), hypercorticsolism, virilization, primary aldosteronism