Adrenal Case Review

Question 1

Hypercortisolic patient, why do they have hypoK and HTN

why do they have polyuria/polydipsia

Answer 1

Cortisol has MC activity

seconday coms of diabetes/hyperGly

Question 2

Etiologies of hypercortisol

Answer 2

Exogenous GC
Pituitary hypersecretion of ACTH
Ectopic ACTH from neoplasm
Hypersecretion of cortsiol by adrenal adenoma/carcinoma

Question 3

Hypercortisolemia pt, ACTH levels <5 indicate

> 20 indicate

ACTH level that is normal o high can indivate

in the presence of high cortisol, normal indiv ACTH levels should be

Answer 3

Adrenal problem

ACTH secreting tumor

ACTH dependent cortisol excess

undetectable

Question 4

Comps of Cushing’s syndrome

M
I
O
D
I

Answer 4

metabolic syndrome
Inc CV risk
Osteoporosis
Depression
Impaired gonad fxn

Question 5

Suspected hypercortisol

1st step
2nd step

ACTH low means, next step
ACTH high/normal indivates

next step

Answer 5

confirm cortisol excess
Check ACTH

adrenal cause, imaging
pituitary/ectopic

HD DM suppression
suppressed- image pituitary
not- look for ca

Question 6

Possible metabolic causes of Addisons dz

lab studies for Addisons

GC insufficiency

MC insufficiency

ACTH stim test w

Answer 6

CAH, enzyme inhibitors (metyrapone, keto, aminoglutethimide)

low AM cortisol, failed ACTH stim test, high ACTH (primary dz)

low Na, high K

cosyntropin

Question 7

Addisons z

Pt w secondary/tertiary insufficiency are not

have near normal synth of ____, not markedly

Answer 7

hyperpigmented (low ACTH)

aldo, hypoNa/hyperK

Question 8

Addison’s Crisis presentation

precipitated by

Tx w

Answer 8

Loss of adrenal fxn, N/V/ab pain, hypoTN, hypovolemic shock/death

sepsis, surgical stress

MC/GC replacement

Question 9

Pt with suspected pheo, hyperCa can indicate

Answer 9

MEN 2A