Adrenal Diseases - Unrein Flashcards
cortisol
protein bound
- increased albumin - will show low cortisol
- malnourished - will show high cortisol
need to draw free cortisol
diagnosis of addisons
cosyntropin stimulation test
-synthetic ACTH
primary - no change
secondary - will change
most common form of adrenal insufficiency
exogenous steroids
biochemical features of adrenal insufficiency
low Na
high K
low blood glucose
metabolic acidosis
volume depletion
difference between primary and secondary adrenal insufficiency
primary - hyperpigmentation
secondary - no hyperpigmentation
- nor severity of electrolyte abnormalities
- aldosterone still working
mineralocorticoid excess
hypokalemia
hypernatremia
HTN
glucocorticoid excess
would see high glucose
cushings diagnosis
24 hour free cortisol in urine
dexamethasone suppression test
looks at ACTH source
low dose - to confirm cushings
high dose - exogenous vs. pituitary ACTH
-high dose - won’t suppress exogenous but will suppress pituitary
low dose dexamethasone
suppress cortiosl in normal individual but fails to suppress cortisol in all causes of cushings
iatrogenic adrenal insufficiency
administer a stress dose of steroids
how long adrenally suppressed after prolonged course of steroids
up to one year
test to be safe before start thyroid supplementation
normal serum Na, K, and glucose
increased thyroid
increases cortisol kidney clearance
licorice
low aldosterone and low serum renin
inhibits the cortisol > cortisone conversion
-so it activates the mineralocorticoid receptor
