Adrenal Cortex

Question 1

MC cause of MIneralocorticoid excess

Answer 1

Primary aldosteronism

Question 2

Aldosterone producing adrenal adenoma

Answer 2

Conns syndrome

Question 3

Inhibits cortisol synthesis at level of 11B synthase

Answer 3

Metyrapone

Question 4

Syndrome of apparent MC excess

Answer 4

Mutations of 11B2HSD

Lack of renal inactivation of cortisol to cortisone

Question 5

Action of 11 b hydroxysteroid dehydrogenase type 1

Answer 5

Cortisol to cortisone

Question 6

\+hypokalemic hypertension
ARR > 750
Confirmed with saline infusion test
Unenhanced CT adrenals normal
\+ FH or early onset HTN

Answer 6

Glucocorticoid remediable aldosteronism

Caused by chimeric gene
cYP11B1 and CYP11B2

Question 7

Anti hypertensives no effect on ARR

Answer 7

alpha blockers and calcium antagonists

Question 8

Side effects of spirinolactone in the treatment of aldosteronism

Answer 8

Menstrual irregularity
Decreased libido
Gyne compadres

Question 9

Mutations in th B or gamma subunits of ENaC, decreasing receptor internalization and degradation

Answer 9

Llddles syndrome

Question 10

Positive ARR

Answer 10

> 750

Question 11

DD:
Suppressed renin
Suppressed aldosterone
Hypokalemic hypertension

High cortisol over cortisone ratio

Answer 11

SAME

Question 12

DD:
Suppressed renin
Suppressed aldosterone
Hypokalemic hypertension

Normal GC/MS profile

Answer 12

Liddles syndrome

Question 13

MC cause of malignant adrenal mass

Answer 13

Mets

Question 14

Contrast wash out after 15 min CT scan of adrenals

Answer 14

> 50 in Benign lesions

Question 15

MX historpathogic classification of adrenal ADENOMAS

Answer 15

Weiss score

Question 16

Most common mets source ACC

Answer 16

Liver

Lungs

Question 17

Most important prognostic histologic parameter in ACC

Answer 17

Ki67 proliferation index

Question 18

MC cause of primary adrenal insufficiency

Answer 18

Autoimmune adrenalitis

Question 19

Differential diagnosis for mineralocorticoid excess

Answer 19

Primary aldosteronism
(bilateral micro ocular hyperplasia, cons, ACc, glucocorticoid remediable aldosteronism
Syndrome of apparent mineralocorticoid excess

Question 20

Screening and

Diagnostic confirmation of mineralocorticoid excess

Answer 20

ARR measurement

Saline infusion test
Oral sodium loading test
Fludrocortisone suppression test

Question 21

Reason for hyponatremia in chronic adrenal insufficiency

Answer 21

Characteristic biochemical feature in primary adrenal insufficiency

Question 22

Reduces cortisol and is used primarily in treatment of adrenocortical carcinoma

Answer 22

Mitotane

Question 23

MC cause of mienralocorticoid excess

Answer 23

Primary huperaldosteronism

Question 24

Treatment of acute adrenal sufficiency

Answer 24

Immediate initiation of rehydration carried out by saline infusion at rates 1L/h with continuous cardiac monitoring

Glucocoryicpid replaxement 100 hydrocortisone 24h