Adrenal Cortex Flashcards
MC cause of MIneralocorticoid excess
Primary aldosteronism
Aldosterone producing adrenal adenoma
Conns syndrome
Inhibits cortisol synthesis at level of 11B synthase
Metyrapone
Syndrome of apparent MC excess
Mutations of 11B2HSD
Lack of renal inactivation of cortisol to cortisone
Action of 11 b hydroxysteroid dehydrogenase type 1
Cortisol to cortisone
\+hypokalemic hypertension ARR > 750 Confirmed with saline infusion test Unenhanced CT adrenals normal \+ FH or early onset HTN
Glucocorticoid remediable aldosteronism
Caused by chimeric gene
cYP11B1 and CYP11B2
Anti hypertensives no effect on ARR
alpha blockers and calcium antagonists
Side effects of spirinolactone in the treatment of aldosteronism
Menstrual irregularity
Decreased libido
Gyne compadres
Mutations in th B or gamma subunits of ENaC, decreasing receptor internalization and degradation
Llddles syndrome
Positive ARR
> 750
DD:
Suppressed renin
Suppressed aldosterone
Hypokalemic hypertension
High cortisol over cortisone ratio
SAME
DD:
Suppressed renin
Suppressed aldosterone
Hypokalemic hypertension
Normal GC/MS profile
Liddles syndrome
MC cause of malignant adrenal mass
Mets
Contrast wash out after 15 min CT scan of adrenals
> 50 in Benign lesions
MX historpathogic classification of adrenal ADENOMAS
Weiss score
Most common mets source ACC
Liver
Lungs
Most important prognostic histologic parameter in ACC
Ki67 proliferation index
MC cause of primary adrenal insufficiency
Autoimmune adrenalitis
Differential diagnosis for mineralocorticoid excess
Primary aldosteronism (bilateral micro ocular hyperplasia, cons, ACc, glucocorticoid remediable aldosteronism Syndrome of apparent mineralocorticoid excess
Screening and
Diagnostic confirmation of mineralocorticoid excess
ARR measurement
Saline infusion test
Oral sodium loading test
Fludrocortisone suppression test
Reason for hyponatremia in chronic adrenal insufficiency
Characteristic biochemical feature in primary adrenal insufficiency
Reduces cortisol and is used primarily in treatment of adrenocortical carcinoma
Mitotane
MC cause of mienralocorticoid excess
Primary huperaldosteronism
Treatment of acute adrenal sufficiency
Immediate initiation of rehydration carried out by saline infusion at rates 1L/h with continuous cardiac monitoring
Glucocoryicpid replaxement 100 hydrocortisone 24h
