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Boards.CP.Chemistry > Adrenal Cortex > Flashcards

Adrenal Cortex Flashcards

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1
Q

Serum cortisol secretion undergoes diurnal variation:

  • Trough
  • Peak
A
  • Trough - Midnight (12 AM)

- Peak - 8 AM

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2
Q

Cushing syndrome is characterized not only by Elevated Serum Cortisol, but also loss of what?

A

Diurnal Variation

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3
Q

Elevated Midnight Serum Cortisol is highly suggestive of what?

A

Cushing Syndrome

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4
Q

Low 8 AM serum Cortisol is highly suggestive of what?

A

Adrenal Insufficiency

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5
Q

Urine Free Cortisol Test:

  • Collection
  • Measures (2)
A

24 hour urine collection

  • Free (unbound) serum Cortisol
  • Independent of time of day considerations
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6
Q

Dexamethasone Suppression Test results in Normal Endocrine function.

A

Dose of Dexamethasone will

-Supress both ACTH and Cortisol

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7
Q

Low-Dose Dexamethasone Suppression Test (DST):
-2 Forms

*Answers what question?

A
  • Rapid (overnight) DST
  • Standard (2 day) DST
  • Does the Pt. have Cushing Syndrome (Hypercortisolism)?
  • If impaired suppression - Yes
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8
Q

What question does the High-Dose Dexamethasone Suppression Test (DST) answer?

A

Is the Cushing syndrome caused by a Pituitary Adenoma

Cushing Disease

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9
Q

High-Dose Dexamethasone Suppression Test (DST):

  • Suppression
  • Nonsuppression (2)
A

Suppression
-Pituitary Adenoma (Cushing Disease)

Nonsuppression*:

  • Ectopic ACTH production (tumor)
  • Primary Adrenal Hypercortisolism

*distinguished by plasma ACTH measurements

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10
Q

What other test is used to determine the cause of Cushing Syndrome?

A

Cortisol Releasing Hormone (CRH) stimulation test

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11
Q

Cortisol Releasing Hormone (CRH) stimulation test:

  • Exaggerated Elevation of ACTH/Cortisol
  • No response (2)
A

Exaggerated Elevation of ACTH/Cortisol:
-Pituitary Adenoma

No Response:

  • Adrenal Tumors
  • Ectopic ACTH
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12
Q

Diagnosis of Cushing Syndrome (Hypercortisolism) requires the demonstration of persistent hypercortisolism. What are the 3 recommended Screening Tests?

A
  • Low-Dose DST
  • 24hr Urinary Free Cortisol
  • Midnight Salivary or Serum Cortisol
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13
Q

ACTH-Dependent Cushing Syndrome is further evaluated by what tests? (3)

A
  • Bilateral Inferior Petrosal Sinus Sampling (BIPSS)
  • High-Dose DST
  • CRH stimulation test
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14
Q

ACTH-Independent Cushing Syndrome:

  • Must Exclude?
  • Requires
A
  • Surreptitious Glucocorticoid administration

- Adrenal Imaging

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15
Q

Most common cause of Cushing Syndrome in developed world.

A

Iatrogenic

-Corticosteroids for Tx of Inflammatory Disease

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16
Q

Cushing Disease is usually found in association with what?

A 
Pituitary Microadenoma (<1.0 cm)
-Basophilic cells (Corticotrophs)
17
Q

What neoplasms are associated with Ectopic ACTH production? (7)

A
  • Small Cell Lung Cancer
  • Lung Carcinoid
  • Pancreatic Endocrine Tumors
  • Non-Small Cell Lung Cancer
  • Thymic Tumors
  • Medullary Thyroid Carcinoma
  • Breast Cancer
18
Q

Primary Adrenal Hypercortisolism may be due to? (3)

A
  • Adrenal Adenoma
  • Adrenal Carcinoma
  • Bilateral Adrenal Hyperplasia
19
Q

What are the Systemic Effects of Cushing Syndrome? (6)

A
  • Hyperglycemia
  • Hypokalemia
  • Protein Catabolism
  • Osteoporosis
  • Centripetal Fat Deposition
  • Skin Thinning w/ Striae
20
Q

What are causes of Pseudo-Cushing syndrome? (4)

A
  • Major Depression
  • Anorexia Nervosa
  • Alcoholism
  • Pregnancy
21
Q

Diagnosis Criteria for Addison Disease (Primary Adrenal Insufficiency). (2)

A
  • Low 8AM serum Cortisol (and/or)

- Blunted increase in Cortisol following Cosyntropin Stimulation

22
Q

The ACTH level is used to guide further evaluation of Addison Disease.

  • Elevated ACTH
  • Next tests
A

Elevated ACTH = Primary Adrenal Insufficiency

  • Autoantibody studies (and/or)
  • Adrenal Imaging
23
Q

The ACTH level is used to guide further evaluation of Addison Disease.
-Normal or Low ACTH (2)

A

WNL/Low ACTH - Secondary Adrenal Insufficiency

  • Pituitary Pathology
  • Exogenous Glucocorticoids
24
Q

Most common cause of Addison’s Disease (Primary Adrenal Insufficiency):

*Historically

A

Autoimmunity

*Tuberculosis - primary destruction of adrenal gland by granulomatous disease

25
Q

What are the characteristic findings in Addisonian Crisis? (6)

A
  • Altered Mental Status
  • Hypotension
  • Hypoglycemia
  • Hyponatremia
  • Hyperkalemia
  • Metabolic Acidosis
26
Q

Clinical Features of Addison’s Disease (Primary Adrenal Insufficiency)? (7)

A
  • Fatigue
  • Weakness
  • Weight Loss
  • Mood Alteration
  • Postural Hypotension
  • Skin Hyperpigmentation
  • Hypoglycemia
27
Q

Most cases of Secondary Adrenal Insufficiency is cause by Exogenous Glucocorticoids, which lead to what?

A

Irreversible (or slowly reversible) suppression of endogenous ACTH production

28
Q

Why is Secondary Adrenal Insufficiency not as severe as Addision’s Disease

A

Minearlocorticoid production is maintained in Secondary by the Renin-Angiotensin System

29
Q

What is the finding in Secondary Adrenal Insufficiency? (1)

-What findings are NOT seen

A

Mild Hyponatremia

  • Hyperkalemia is Absent
  • Hyperpigmentation is NOT seen
30
Q

Hyperaldosteronism is also known as what?

A

Conn Syndrome

31
Q

Conn Syndrome (Hyperaldosteronism) is usually caused by what? (2)

A
  • Adrenal Adenoma

- Bilateral Adrenal Hyperplasia

32
Q 
Conn Syndrome (Hyperaldosteronism):
-Findings (3)
A
  • HTN
  • Hypokalemia
  • Metabolic Alkalosis
33
Q

What is the best screening test for Conn Syndrome (Hyperaldosteronism)?

*Confirmatory Test

A

Plasma Aldosterone Concentration (PAC) to Plasma Renin Activity (PRA)
-[PAC:PRA]

*24 hour urinary Aldosterone level

34
Q

Secondary Hyperaldosteronisms is seen in what state?

-Causes (2)

A

Hyperreninemic States

  • Renal Artery Stenosis
  • Jutaglomerular Cell Tumor of Kidney (Renin Producing)
35
Q

What is the most common cause of Congenital Adrenal Hyperplasia (CAH)?
-2nd MC

A

21-Hydroxylase deficiency

-11-Hydroxylase deficiency

36
Q

Where is the gene for 21-Hydroxylase found? (2)

A 
Chromosome 6 (6p21.3)
-within HLA complex
37
Q

What are the characteristic serum labs seen in CAH? (6)

A
  • 17-Hydroxyprogesterone (High)
  • Cortisol (Low)
  • ACTH (High)
  • Androgens (High)
  • 17-ketosteroids (High)
  • Aldosterone (Low)
38
Q

21-Hydroxylase deficiency Vs. 11-Hydroxylase deficiency - Both show Adrenal Hyperplasia and Virilzation. What findings differ between the two?

A

21-Hydroxylase deficiency
-Salt Wasting

11-Hydroxylase deficiency
-HTN

Boards.CP.Chemistry (17 decks)

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