Adrenal Cortex and Medulla

Question 1

Hyperaldosteronism etiologies

Answer 1

primary: from adenoma
secondary: from activation of RAAS

Question 2

1˚ hyperaldosteronism
etiology
labs: aldosterone and renin

Answer 2

adrenal adenoma

high aldosterone, low renin

Question 3

2˚ hyperaldosteronism
etiology
labs: aldosterone and renin

Answer 3

fibromuscular dysplasia in young woman, artherosclerosis in older adults
high renin, high aldosterone

Question 4

Manifestation of hyperaldosteronism

Answer 4

hypertension (increased Na and water reabsorption)
hypokalemia (increased K excretion)
metabolic alkalosis (increased H excretion in alpha intercalated cells)

Question 5

Aldosterone effects on kidney

Answer 5

in DCT and collecting duct
principle cells: increase Na reabsorption and K excretion
alpha-intercalated cells: excretion of H

Question 6

Cushing syndrome definition

Answer 6

high cortisol in blood

Question 7

Presentation of Cushing syndrome

Answer 7

muscle weakness: cortisol breaks down protein
moon facies, buffalo hump, truncal obesity: due to high insulin, fat storage centrally
abdominal striae: due to impaired collagen synthesis and thinning of skin
osteoporosis

Question 8

How does cortisol cause immunosuppression

Answer 8

inhibit phospholipase A2: no AA metabolites
inhibits IL-2 secretion
inhibits His release from mast cells

Question 9

Which Cushing syndrome responds to the dexamethasone suppression test

Answer 9

Cushing disease

*primary anterior pituitary ACTH-secreting tumor

Question 10

Most common cause of Cushings

Answer 10

exogenous glucocorticoids

Question 11

Adrenal hyperplasia/atrophy in Cushings syndromes:

• exogenous steroids
• ACTH-secreting pituitary adenoma
• ACTH paraneoplastic syndrome
• primary adrenal adenoma, hyperplasia, carcinoma

Answer 11

• exogenous: bilateral atrophy
• ACTH-secreting pituitary adenoma: bilateral hyperplasia
• ACTH paraneoplastic syndrome: bilateral hyperplasia
• primary adrenal pathology: one hyperplasia, one atrophy
• based on fact that ACTH exposure makes them large and lack of ACTH makes them atrophy

Question 12

Congenital adrenal hyperplasia

etiology

Answer 12

enzymatic defects in cortisol production

Question 13

Congenital adrenal hyperplasia

why is it hyperplastic?

Answer 13

high ACTH due to negative feedback

leads to hyperplasia of adrenals

Question 14

Presentation of adrenal hyperplasia

Answer 14

clitoral enlargement in females

precarious puberty in males

Question 15

Most common subtype of congenital adrenal hyperplasia

Answer 15

21-hydroxylase deficiency

Question 16

Acute adrenal insufficiency classically caused by

Answer 16

Waterhouse-Fridrichsen syndrome
hemorrhagic necrosis of adrenal glands
2˚ to DIC in young children w/ Neisseria menengitidis infection
lack or cortisol exacerbates hypotension, leading to death

Question 17

Chronic renal insufficiency

common etiologies

Answer 17

• autoimmune
• tuberculosis infection
• lung mets to adrenals**

Question 18

Gross appearance Waterhouse-Friderichsen syndrome

Answer 18

“sack of blood” adrenals

Question 19

Clinical features of Addisons

Answer 19

hypotension, hyponatremia, hypovolemia, hyperkalemia, metabolic acidosis, weakness, hyperpigmentation, vomiting, diarrhea

Question 20

Adrenal medulla tumor

Answer 20

pheochromocytoma

secretes epi and NE episodically

Question 21

Pheochromocytoma is tumor of

Answer 21

chromaffin cells in adrenal medulla (neural crest derivation)

Question 22

Sx of pheochromocytoma

Answer 22

hypertension, headache, palpitations, tachycardia, sweating

Question 23

Dx of pheochromocytoma

Answer 23

increased serum metanephrines and increased 24-hour urine metanephrines and vanillylmandelic acid

Question 24

Tx of pheochromocytoma

special consideration before surgery

Answer 24

phenoxybenzamine
irreversible alpha antagonist
prevents hypertensive crisis when surgeon squeezes on tumor

Question 25

Which adrenal tumor can sometimes be found somewhere other than the adrenal gland

Answer 25

pheochromocytoma
often in bladder
**Sx may occur when urinating!!