Adrenal Disease Lecture Powerpoint Flashcards
Cushing’s syndrome and different sources
Adrenal hyperplasia causing excess cortisol production
-pituitary hyperplasia, pituitary ACTH overproduction, ectopic ACTH production from a tumor producing a similar substance, adrenal adenoma, adrenal cancer, or prolonged use of steroids
Cushing’s syndrome screening tests (3)
- Overnight dexamethasone suppression test (administer 1mg PO 11pm, serum cortisol next day taken at 8am, should suppress to <2ug/dL in healthy patient, abnormal >10ug/dL)
- 24 hr urine free cortisol measure (normal less than 50-75 ug in 24 hrs)
- late night salivary cortisol
Lesion location in confirmed screening cushing’s syndrome
Radiographic studies to confirm suspicion? (3)
- ACTH and cortisol both high (pituitary or ectopic ACTH)
- ACTH low and cortisol high (indicates adrenal or iatrogenic origin)
- Pituitary MRI (only 50% accurate)
- Petrosal venous sinus sampling
- Abdominal CT or MRI’s
Cushing’s disease involves the ___
pituitary gland
Cushing’s syndrome treatment post op (1)
-Tapering doses of steroids to prevent addisonian crisis using hydrocortisone potentially taking up to a year
Addison’s disease
Chronically low cortisol levels due to primary adrenalcortical deficiency that progresses to destroy greater than 90% of the adrenal mass and may be associated with other endocrine autoimmune diseases, ACTH buildup in body darkens skin patches
Addison’s disease presenting signs and symptoms (5)
- Fatigue, weakness, anorexia
- N/V
- Pigmentation of skin
- hypotension
- hypoglycemia
Lab evaluation of addison’s disease
- Hyperkalemia and hyponatremia
- <10ug/dL serum AM cortisol
- ACTH stimulation test
ACTH stimulation test
Test for evaluation of Addison’s disease where .25 mg ACTH IV or IM administered and then ACTH, cortisol, and aldosterone levels at 30, 60, and 90 min are compared to baseline value, normal to see >18-20 ug/dL during test, otherwise is abnormal response indicative of addison’s dz
Adrenal insufficiency treatment options (2)
- Daily hydrocortisone 20mg in AM, 10mg in late afternoon
- fludrocortisone (aldosterone agonist) .1mg per day with salt
Increasing daily hydrocortisone doze in adrenal insufficiency or illness/surgery recovery treatment adjustment scale
- Increase when sick or stressed using 3x3 rule (3x usual daily dose for 3 days)
- Injectible steroids available for emergency use
- Identification jewelry
Adrenal testing for suspected adrenal crisis
- Perform high dose ACTH stimulation test, getting baseline ACTH and cortisol, 20. 30, and 60 min post injection cortisones
- Cover patient with dexamethasone (potent steroid)
- Administer IV saline and glucose
Treatment for secondary adrenal insufficiency (2nd to previous high dose prolonged use of potent exoogenous steroids causing chronic ACTH suppression)
-20mg/day of prednisone for >3 weeks (high dose, long period of time)
Primary hyperaldosteronism causes (2)
-Either due to a solitary adenoma (bump on one adrenal gland making excess aldosterone that can be removed via surgery) or bilateral idiopathic hyperplasia (familial inheritance, treated with sprionolactone)
Primay hyperaldosteronism clinical features (3)
- Particularly severe hypertension
- Low serum K+
- Muscle weakness and polyuria
