Adrenal Flashcards
Action of cortisol
Cho ptn fat
- Hyperglycemia
Catabolic
Lipolytic → redistribution of fat
4 anti in cortisol
’ Anti-vitamin D
Anti-inflammatory
Anti-allergic → ↓ lymphocytes ↓ eosinophils, basophils
Anti-stress
Action of cortisol on blood
↑ RBCs
↑ neutrophils
Action of cortisol on blood
↑ RBCs
↑ neutrophils
Feature suggest ectopic ACTH
O short duration ② weigh loss ③ severe ↓ K ④ severe DM
Investigation of Cushing
- 24-hr free urinary cortisol
- low- dose dexamethasone suppression test
Gold standard for distinguishing between () Cushing D. And ectopic Cushing
IPSS
In IPSS if ratio 1:1
Ectopic Cushing
Medical TTT in Cushing
① metyrapone →ß-hydroxyls blocker
② ketoconazole → hepatotoxicity
③ ↓ ACTH
Sarcoidosis and hemochromatosis’s cause
1 ry Addison
The most common cause of I primary Addison in developed
Autoimmune
C/p of Addison
↓↓↓
Hypoglycemia
Hypotension
Asthenia
↑↑↑
Hyper pigmentation in 1ry
Hyper acidosis
Hyper k+
TTT of Addison
- Steroid replacement
Hydrocortisone or predmisolone - aldosterone replacement
Fluoro cortisone acetate
*
Vitamin D
Sudden withdrawl of chronic cortisone therapy cause
Adrenal crisis
Waterhouse-freid Chon cause
Adrenal crisis
TTT of adrenal crisis
IV fluid
Cortisone
Regulation of: aldosterone
Angiotensin Il
Extra K level
Secondly hyperaldestorism with HTN
Renal A. Stenosis
Cause of 2 ry ↑ aldosterone
Renin-producing tumor
Renal A stenosis
It vent HF
Nephrotic
Cor pulmonale
C/p of conn’s
① hypertension manifest
② hypokalemica
Ms weakness - fatigue - polyuria
③ alkalosis
Tetany Ca
Plasma renin activity in Conn
Suppressed
T TT in Conn [ adrenal hyperplasias]
Aldosterone antagonist
(1) spironolactone
Pheochromocytoma associated with
30%
① VHL syndrome
② men 2
③ NF 1
④ HOCM
C/p of pheocromocytoma
- Headache
*Palpitation - sweating
- postural hypotension
- hypertension
- tachyarrythemia
- café au Lait spots
End-product of catecholamine
Vanillymandelic acid
Adverse effects of oral corticosteroid therapy Include
a. Peptic ulceration
b. Hypertension
c. Avascular bone necrosis
Postural hypotension and systole BP ↓ 20 and diastole BP ↓ 10
Common in
Adrenal insufficiency
Short synacthen test diagnostic to
Adrenal failure
- All of the following are featured by dermal hyperpigmentation
B. Bronchogenic carcinoma C. Addison’s disease
D. Hemochromatosis
E. Nelson’s syndrome
Weight In pheocromocytoma
Loss
Vanillylmandelic acid (VMA) excretion is increased in urine in:
Pheochromocytoma
DDX of pheochromocstome
B. Primary aldosteronism C. Hypoglycemia
D. Cushing’s disease
E. Fibromuscular dysplasia
initial test to confirm the diagnosis of Cushing’s syndrome?
Low dose dexamethazone suppression te
What are the major effect of excess cortisol?
Catabolic+ immunosuppression
Adrenal Hge and insufficiency due to N. meningitides is called:
Waterhouse-Frederichsen syndrome