Adrenal Disease Flashcards
adrenal cortex produces what?
- glucocorticoids
- mineralocorticoids
- sex hormones (mainly tertosterone)
principal glucocorticoid
cortisol
principal mineralocorticoid
aldosterone
main effects of aldosterone
- increased Na+ reabsorption
- K+ and H+ excretion
(both at distal renal tubule)
potential causes of Cushing’s syndrome
- steroid therapy
- adrenal hyperplasia
- adrenal carcinoma
- ectopic ACTH
cause of Cushing’s disease
ACTH secreting pituitary tumor
clinical features of Cushing’s
- moon face
- thin skin
- easy bruising
- HTN (60%)
- hirsutism
- obesity w/ centripetal distribution
- buffalo hump
- muscle weakness
- DM (10%)
- OP (50%)
- aseptic necrosis of hip
- pancreatitis (esp w/ iatrogenic Cushing’s syndrome)
potential problems w/ Cushing’s
- hyperglycemia –> +/- insulin
- hypokalemia –> arrhythmias, muscle weakness, post-op respiratory impairment
- HTN
- polycythemia
- HF
common cause of primary adrenocortical insufficiency
autoimmune adrenalitis (Addison’s disease)
other causes of primary adrenocortical insufficiency
- adrenal infiltration w/ tumor
- leukemia
- infection (TB or histoplasmosis)
- amyloidosis
cause of secondary adrenocortical insufficiency
ACTH (adrenocorticotrophic hormone) deficiency
acute (Addisonian) crisis may result from
- after sepsis
- pharmacological adrenal suppression
- adrenal hemorrhage a/w anticoagulation
acute (Addisonian) adrenocortical crisis may also present as
post-partum pituitary infarction (Sheehan’s syndrome)
clinical features of acute adrenocortical crisis
- apathy
- hypotension
- coma
- hypoglycemia
- circulatory failure and shock
- h/o recent infection
chronic adrenocortical deficiency may result from
- surgical adrenalectomy
- autoimmune adrenalitis
- secondary to pituitary dysfunction
clinical features of chronic adrenocortical crisis
- fatigue
- weakness
- weight loss
- nausea
- hyperpigmentation
- hypotension
- hyponatremia
- hyperkalemia
- eosinophilia
- occasionally hypoglycemia
bmp results in adrenocortical insufficiency
- hyponatremia
- hypochloremia
- hyperkalemia
- hypercalcemia
- hypoglycemia
- elevated BUN
cbc results in adrenocortical insufficiency
- elevated hematocrit (from dehydration)
- possible eosinophilia
expected cortisol level in adrenocortical insufficiency
low
expected ACTH level in priamry adrenocortical insufficiency
high
expected ACTH level in secondary adrenocortical insufficiency
low or normal
abg results in adrenocortical insufficiency
metabolic acidosis +/- respiratory acidosis if severe muscle weakness
management of adrenocortical insufficiency
- admit to critical care unit
- invasive monitoring or circulatory pressures
- abgs
management of circulatory shock in acute adrenocortical crisis
- large volumes of isotonic saline (6-8 liters) in 24 hours
- +/- inotropic therapy
- corticosteroids!! (don’t wait for confirmatory lab results)
steroid of choice in acute adrenocortical crisis
hydrocortisone (100-200 mg bolus) then q6h
patients who have been on steroids for how long and how much are at risk of acute Addisonian-type crisis from steroid w/d?
10 mg daily > 1 year
cause of primary hyperaldosteronism (Conn’s syndrome)
adenoma in zona glomerulosa secreting aldosterone
clinical features of primary hyperaldosteronism (Conn’s syndrome)
- hypokalemia
- muscle weakness
- HTN
problems w/ primary hyperaldosteronism (Conn’s syndrome)
- hypokalemia –> cardiac arrhythmias, post-op weakness, ventilatory impairment
- HTN
- hormone replacement post adrenalectomy
