Adrenal Flashcards
Adrenal Medulla secretes?
Catecholamines:
Epi, Norepi
Adrenal Cortex: Zona Glomerulosa secretes?
Mineralcorticoids: Aldosterone
Adrenal Cortex: Zona Fasciculata secretes?
Glucocorticoids: Cortisol
Adrenal Cortex: Zona Reticularis secretes?
Androgens: DHEA
Adrenal hormones excreted how?
Urine as metabolites
Cushing’s Synd/ACTH-dependent caused by?
1) Excess ACTH from pituitary tumor ** most common
2) Excess ACTH from ectopic tumors (i.e. small cell lung CA)
3) Excess CRH from hypothalm
Cushing’s Synd/ACTH-independent caused by?
1) Adrenal tumor
2) Hyperplasia from excess receptor/hormone
3) Neuroendrocrine tumor
4) Pheochromocytoma (medulla tumor)
Cushing’s Synd/ACTH-dependent epidemiology?
More common
F»M
25-45yo
Cushing’s Synd/ACTH-independent epidemiology?
M=F
Bimodal age
Cushing’s presentation?
Weight gain Proximal mm fatigue/weakness Straie Acne/hair Edema
Cushing’s physio ∆s?
HTN Insulin resistance Osteoporosis/hyperCa2+ Psych Clitoral hypertrophy Impotence
Cushing’s labs? (5)
Easiest/cheapest: DST = cortisol >5
Definitive: 24 hr urine cortisol > 125
Plasma cortisol = high
Serum ACTH = high in ACTH-dep and low in indep
Saliva = high cortisol in p.m.
Cushing’s management?
Remove/destroy tumors
Inoperable, see meds
Cushing’s tx w/ meds?
Adrenolytic (Mitotane): destruction of adrenocortical cells
Adrenal Enz Inhib (Ketoconazole, Metyrapone)
Virilization is?
development of male physical characteristics
Adrenal Insufficiency is?
Inadequate prdxn of mineral/gluco/androgen hormones
Primary Adrenal Insufficiency caused by? (2 categories)
Destruction of gland:
Autoimm, surgical, infect, CA
Metabolic failure:
adrenal hyperplasia, adrenoleukodystrophy
Most common cause of Primary Adrenal Insufficiency?
Addison’s (autoimmune)
Secondary Adrenal Insuff caused by?
Abrupt stop of external steroid (most common)
Hypopituitary
Steroid-reducing drugs
Adrenal Insuff presentation?
TETRAD: Weak/fatigue Weight loss Hyperpigment (include muc memb) HypoTN
Adrenal Insuff from ↓ glucocort presentation?
Tetrad
+ hypoglycemia
N/V abd pain
Adrenal Insuff from ↓ mineralcocort presentation?
Tetrad
+ hypoNa+/hypovol
HyperK+
Acidosis
Adrenal Insuff from ↓ androgens presentation?
Tetrad
+ Ø pubic hair/amenorrhea in women
Adrenal Insuff labs?
Cosyntropin Stim Test: baseline cortisol then post ACTH bolus cortisol
+ result = cortisol Ø ↑ > 18 AND Ø ↑ > 7 above baseline
(doesn’t tell me cause)
Plasma cortisol = low
Serum ACTH = high (addison’s), low (hypopitu)
Adrenal Insuff diagnositcs must r/o?
TB (PPD test)
Lung/Breast CA
Vascular dz
Adrenal Insuff rx?
Replace hormones
Increase glucocort during stress
Primary Hyperaldosteronism (Conn Synd) caused by?
(U) Adrenocortical adenoma
Cortical hyperplasia
Conn synd presentation?
HTN HypoK+ mm weakness Paresthesia HA Polyuria/Polydipsia
Conn Synd labs/test?
Plasma and urine aldosterone = high
Plasma renin = low
CT for adenoma
Conn Synd tx?
Remove tumor
Spironolactone/antihypertensives
Pheochromocytoma is?
Catecholamine-producing tumor of neurochromaffin cells
Pheochromocytoma epidemiology?
Sporadic or Familial
any age (peak 40-50yo)
Fatal if not tx
Pheochromocytoma etiology?
(U) in medulla
or extra-adrenal
(P) neurofibromatosis
RULE OF 10s
Extraadrenal Pheochromocytoma located?
SNS spinal chain
Aorta
Ureter
Bladder
Pheochromocytoma presentation?
Paroxysm attacks:
HA, sweating, palp, acute HTN
(P) mass
Thyroid storm
Key point of Pheochromocytoma-caused HTN?
If pt HTN not responding to tx, workup for catecholamine excess
Pheochromocytoma labs?
Definitive: Clonidine Suppress Test = no epi reduction after clonidine
Thyroid fxn
Plasma/urine catecholamnies/metabolites
24 hr urine catech, metaneph, VMA
Causes of false + for catecholamines/metanephrines?
TCA Beat block Acetamin ETOH HTN med w/draw MI/stroke/sleep apnea
Pheochromocytoma tx?
IV nitro for crisis
Chemical sympathectomy w/ alpha block (surgical prep)
Surgery
