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Key Topics in Critical Care Medicine > Adrenal Disease > Flashcards

Adrenal Disease Flashcards

1
Q

adrenal cortex produces what?

A
  • glucocorticoids
  • mineralocorticoids
  • sex hormones (mainly tertosterone)
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2
Q

principal glucocorticoid

A

cortisol

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3
Q

principal mineralocorticoid

A

aldosterone

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4
Q

main effects of aldosterone

A
  • increased Na+ reabsorption
  • K+ and H+ excretion

(both at distal renal tubule)

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5
Q

potential causes of Cushing’s syndrome

A
  • steroid therapy
  • adrenal hyperplasia
  • adrenal carcinoma
  • ectopic ACTH
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6
Q

cause of Cushing’s disease

A

ACTH secreting pituitary tumor

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7
Q

clinical features of Cushing’s

A
  • 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)
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8
Q

potential problems w/ Cushing’s

A
  • hyperglycemia –> +/- insulin
  • hypokalemia –> arrhythmias, muscle weakness, post-op respiratory impairment
  • HTN
  • polycythemia
  • HF
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9
Q

common cause of primary adrenocortical insufficiency

A

autoimmune adrenalitis (Addison’s disease)

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10
Q

other causes of primary adrenocortical insufficiency

A
  • adrenal infiltration w/ tumor
  • leukemia
  • infection (TB or histoplasmosis)
  • amyloidosis
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11
Q

cause of secondary adrenocortical insufficiency

A

ACTH (adrenocorticotrophic hormone) deficiency

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12
Q

acute (Addisonian) crisis may result from

A
  • after sepsis
  • pharmacological adrenal suppression
  • adrenal hemorrhage a/w anticoagulation
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13
Q

acute (Addisonian) adrenocortical crisis may also present as

A

post-partum pituitary infarction (Sheehan’s syndrome)

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14
Q

clinical features of acute adrenocortical crisis

A
  • apathy
  • hypotension
  • coma
  • hypoglycemia
  • circulatory failure and shock
  • h/o recent infection
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15
Q

chronic adrenocortical deficiency may result from

A
  • surgical adrenalectomy
  • autoimmune adrenalitis
  • secondary to pituitary dysfunction
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16
Q

clinical features of chronic adrenocortical crisis

A
  • fatigue
  • weakness
  • weight loss
  • nausea
  • hyperpigmentation
  • hypotension
  • hyponatremia
  • hyperkalemia
  • eosinophilia
  • occasionally hypoglycemia
17
Q

bmp results in adrenocortical insufficiency

A
  • hyponatremia
  • hypochloremia
  • hyperkalemia
  • hypercalcemia
  • hypoglycemia
  • elevated BUN
18
Q

cbc results in adrenocortical insufficiency

A
  • elevated hematocrit (from dehydration)

- possible eosinophilia

19
Q

expected cortisol level in adrenocortical insufficiency

A

low

20
Q

expected ACTH level in priamry adrenocortical insufficiency

A

high

21
Q

expected ACTH level in secondary adrenocortical insufficiency

A

low or normal

22
Q

abg results in adrenocortical insufficiency

A

metabolic acidosis +/- respiratory acidosis if severe muscle weakness

23
Q

management of adrenocortical insufficiency

A
  • admit to critical care unit
  • invasive monitoring or circulatory pressures
  • abgs
24
Q

management of circulatory shock in acute adrenocortical crisis

A
  • large volumes of isotonic saline (6-8 liters) in 24 hours
  • +/- inotropic therapy
  • corticosteroids!! (don’t wait for confirmatory lab results)
25
Q

steroid of choice in acute adrenocortical crisis

A

hydrocortisone (100-200 mg bolus) then q6h

26
Q

patients who have been on steroids for how long and how much are at risk of acute Addisonian-type crisis from steroid w/d?

A

10 mg daily > 1 year

27
Q

cause of primary hyperaldosteronism (Conn’s syndrome)

A

adenoma in zona glomerulosa secreting aldosterone

28
Q

clinical features of primary hyperaldosteronism (Conn’s syndrome)

A
  • hypokalemia
  • muscle weakness
  • HTN
29
Q

problems w/ primary hyperaldosteronism (Conn’s syndrome)

A
  • hypokalemia –> cardiac arrhythmias, post-op weakness, ventilatory impairment
  • HTN
  • hormone replacement post adrenalectomy

Key Topics in Critical Care Medicine (4 decks)

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