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Endocrine > Adrenal > Flashcards

Adrenal Flashcards

1
Q

What are the symptoms and signs of excess cortisol?

A 
Central obesity (Apple on a stick)
Proximal muscle weakness
Thin skin
Easy bruising
Osteoporosis/fragility fractures
Moon face
Supraclavicular fullness, Buffalo hump
Violacious striae
New or increasing hypertension
Acne(only in disease)
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2
Q

How do we diagnose disorders of excess cortisol?

A
  1. Clinical diagnosis
  2. Confirm increased cortisol
  3. Determine acth dependant or independent
  4. Imaging
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3
Q

What zone produces aldosterone?

A

Zone Glomerulosa

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4
Q

What zone produces cortisol?

A

Zona fasiculata

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5
Q

What zone produces androgens?

A

Zona reticularis

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6
Q

What zone produces catecholamines?

A

Adrenal medulla

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7
Q

What mutation is present in congenital adrenal hyperplasia?

A

Mutations in CYP21B gene, which encodes enzyme 21 hydroxylase

Means problems converting progesterone precursors to deoxycortoisol products

Means low aldosterone and low cortisol

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8
Q

What are the classic findings of 21-OH deficiency?

A

No aldoSterone: low sodium, high potassium, acidosis, hypotension, high renin

No cortisol: failure to thrive, lethargic, hypoglycemia

High ACTH: pigmentation and enlarged adrenal vortices

Excess adrenal androgens: ambiguous genitalia in females precocious puberty in males

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9
Q

What increases ACTH secretion?

A

ADH
Stress
Gut hormones: CCK
Hypothalamus: CRH

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10
Q

What are the actions of glucocorticoids

A

Cardiovascular: increase cardiac output, increase peripheral vascular tone , “permissive”,

Skin: wound healing, collagen production

Metabolism: increase insulin resistance, adipocytes, decrease muscle protein synthesis

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11
Q

What are the normal patterns for glucocorticoid secretion?

A

Pulsating
Circadian rhythm
Negative feedback inhibits axis

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12
Q

What causes primary adrenal insufficiency?

A
  1. Autoimmune (addisons)
  2. TB
  3. Congenital hyperplasia
  4. X linked disease

Infiltration, drugs, etc

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13
Q

What are the cardinal features of primary adrenal insufficiency?

A

Hyperkalemia
Skin hyperpigmentation
Vitiligo (autoimmune)
Salt craving

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14
Q

What serious presentation happens in primary adrenal insufficiency?

A

Shock: usually mostly distributive but also hypovolemic and cardiogenic

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15
Q

What causes central or secondary adrenal insufficiency?

A

Rapidly stopping chronic prednisone treatment: body needs time to catch up again

Pituitary or hypothalamic disease

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16
Q

What is the ddx for an incidental adrenal mass?

A

Adrenal cortical tumors*: carcinoma, adenoma, nodular hyperplasia

Adrenal medullary tumors: pheochromocytoma

Cysts
Hematoma
Infection
Mets

17
Q

What investigations should be done on an incidental adrenal mass?

A

History and physical for signs of endocrine derangements, mass effects

Labs:
24h urine metanephrines
24h urine cortisol, Dxm suppression test 
Aldosterone renin ratio
Adrenal androgens

Imaging: CT

18
Q

What features of an incidental adrenal mass indicate benign vs malignant?

A

Benign: less than 10 HU or 4cm, washout more than 50% at 10min

Malignant: more than 10 HU 04 6cm

19
Q

What are the clinical features of primary aldosteronism?

A

Secondary cause of hypertension
Hypokalemia
Incidental adrenal mass

May be asymptomatic

20
Q

How is primary aldosteronism investigated?

A

Screen with aldosterone renin ratio: >555

Diagnose with suppression test, either salt load or fludrocortisone

Look for underlying cause using CT! Adrenal vein sampling

21
Q

What causes pheochromocytoma

A

Catecholamines secreting tumors in adrenal or sympathetic chain
May be associated with other diseases: neurofibromatosis, MEB2a/b, medullary thyroid cancer, Von hippel Lindau,

22
Q

What are the cardinal symptoms of pheochromocytoma

A

Headache
Palpitations
Sweating

Happening in episodic spells and not necessarily at stressful times

23
Q

What is the work up for pheochromocytoma

A

24h urine metanephrines and normetanephrines.

Plasma free metanephrines

CT/MRI for mass

24
Q

What must be done before surgical resection of pheochromocytoma causing mass?

A

Rigorous blockade of catecholamines, otherwise can have huge surge

25
Q

How does high cortisol cause;

Decreased libido
Polyuria
Hypertension 
Muscle atrophy
Osteoporosis 
Acne
A

Decreased libido: cortisol inhibits gonadotropins

Polyuria: from mass effect on pituitary or from diabetes mellitus

Hypertension: stimulation of mineralcorticoid receptors

Muscle atrophy: decreased protein synthesis

Osteoporosis: inhibition of osteoblasts activity

Acne: only if too much ACTH, causing androgen excess

26
Q

What does IPSS tell us?

A

If ACTH production is really coming from pituitary mass or if it is ectopic

Endocrine (12 decks)

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