Adrenal Flashcards
What are the three zones of the adrenal cortex and what do each secrete
zona glomerulosa secretes mineralocorticoids (aldosterone) zona fasciculata (glucocorticoids-cortisol) zona reticularis (sex steroids)
The ____ sampling of the two adrenal glands is different
venous (L goes through renal vein but R does not)
Some causes of hypercortisolism
exogenous steroids, ACTH dependent pituitary, ACTH Cushing’s, adrenal adenoma
Clinical manifestations of hyper cortisolism
(cushinggoid)
purple striae, moon facies, hyperglycemia, HTN, hyperpigmentation, thinning skin, change fat deposition
Complications of hypercortisolism
CV risk, thromboemoli, muscle weak, more osteoporosis, neurophysical symptoms, increased morbidity/mortality
What testing is done to diagnose Cushing’s
Dexamethasone suppression test, 24 hour urine free cortisol, late night salivary cortisol
Treatment of hypercortisolism depends on ____
etiology
If hypercortisolism etiology is pituitary ademona, what do you do
surgery, meds (cabergoline, pasireotide, mifepristone), irradiation, adrenalextomy
If hypercortisolism etiology is ACTH what do you do
ID and remove tumor
Can’t? treat with adrenal enzyme inhibitors
If hypercortisolism etiology is adrenal adenoma
unilateral adrenalectomy
If hypercortisolism etiology is bilateral adrenal hyperplasia
get rid of adrenals, replace hormones or adrenal enzyme inhibtiors
______ is 11 fold more likely in people with Celiac
autoimmune adrenalitis
What are the two signs of autoimmune adrenalitis
21hydroxylase antibodies
Elevated ACTh may be early sign
What are the two autoimmune adrenalitis and how do they manifest differently
Polyglandular autoimmune syndrome 1 and 2
1: hypoparathyroidism, mucocutaneous candidiasis, adrenal insufficiency, hypogonadism, malnutrition
2: hypogonadism, hypopituitarism, vitiligo/MG/RA/anti-phospholipid. NO hypoparathyroidism
What are some causes of adrenal insufficiency
ID: TB, fungal, HIV, syphilis,
Adrenal infarct
hemorrhage infarct from meningitis. (Waterhouse friderichsen)
metastatic dz
Secondary causes of adrenal insufficiency
pituitary mediated, hypophysitis
Tertiary causes of adrenal insufficiency
hypothalamic, brain injury, med induced, chronic glucocorticoid
Lab findings in adrenal insufficiency
hyponatremia, hyperkalemia, low cortisol, high ACTH
high ADH and decreased aldosterone
What is the corticotropin stimulation test
give so much ACTH that adrenal gland has to release cortisol. In AI, it won’t release sufficient cortisol
What are features of adrenal crisis
dehydration, hypotension, shock, N/V, abdominal pain, unexplained hypoglycemia, unexplained fever, hypo Na+, hyper K+, azotemia
What do you give to treat adrenal crisis
steroids, mimicking endogenous cortisol rhythm
What are signs and symptoms of adrenal cortex disorders
resistant HTN, Hypo K+, increased CV risk
How to diagnose and treat adrenal cortex disorders
check renin/alodertone
confirmatory testing with salt loading
treat with mineralocorticoid antagonists (aldactone/eplerenone), unilateral or subtotal adrenalectomy
The Thing that most commonly goes wrong in the adrenal gland is
21-α hydroxylase pathway
Need to watch for _____ in someone who is sus for Cushing’s
exogenous steroid use
Clinical manifestation of primary and secondary AI
tiredness, weakness, mental depression, anorexia, dizziness, N/V
With an adrenal adenoma you must rule out
Cushing’s and pheochromocytoma
Adrenocortical carcinoma main takeaway
everything’s goes back quickly (sick quickly), hypercorticsolism, virilization, primary aldosteronism
