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RRCCPA Clinical Medicine I > Adrenal Disorders 1 > Flashcards

Adrenal Disorders 1 Flashcards

1
Q

Where are the adrenal glands located?

A

Above kidneys in retroperitoneal space

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2
Q

Outermost zone of adrenal cortex?

A

Zona Glomerulosa

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3
Q

Middle zone of adrenal cortex?

A

Zona Fasiculata

largest zone

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4
Q

Inner most zone of adrenal cortex?

A

Zona reticularis

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5
Q

What class of hormone does the zona glomerulosa produce? And what does it regulate?

A

Mineralocorticoids
-Aldosterone

Regulates blood pressure & electrolyte homeostasis

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6
Q

What class of hormone does the zona fasciculata Produce? And what does it regulate?

A

Glucocorticoids
-Cortisol

Regulate stress response, immune system, metabolism

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7
Q

What class of hormone does the Zona reticularis produce? What are they converted to?

A

Androgens
-DHEA

Converted to sex steroids (estrogen/testosterone)

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8
Q

True or false: The adrenal medulla makes catecholamines including: Epinephrine, norepinephrine, and serotonin?

A

False:
Epinephrine
Norepinephrine
small amounts of dopamine

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9
Q

________ is synthesized from cholesterol.

A

Aldosterone

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10
Q

Aldosterone production is stimulated by increased ________ levels and _________

A

Potassium and angiotensin II

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11
Q

Aldosterone acts on distal convoluted tubules & collecting ducts to….

A
  • Increase reabsorption of Na+

- increase extretion of K+ and H+ ions

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12
Q

Main glucocorticoid in the body? (the stress hormone

A

Cortisol

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13
Q

Precursor of cortisol

A

cholesterol

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14
Q

Actions of cortisol

A
  • Increases circulation level of glucose
    • stim gluconeogenesis
    • smaller role in glycogenolysis

Suppresses immune system, anti-inflammatory

- decrease absorption of Ca++ in GI
 - decreases osteoblast capacity to produce new bone
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15
Q

At what time of day does cortisol peak?

A

~8am

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16
Q

At what time of day does cortisol reach its lowest concentrations? Why?

A

12-4am

Due to circadian rhythm of ACTH

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17
Q

Pathway of the Hypothalamic-pituitary-adrenal axis?

A

Hypothalamus (corticotropin-releasing hormone) –> Anterior Pit (adrenocorticotropic hormone) –> Adrenal gland (cortisol) –> causes many effects in the body–>negative feedback to hypothalamus/pit

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18
Q

DHEA stands for

A

Didehydroepiandrosterone

Now say that 5 times fast

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19
Q

DHEA is produced from_______.

A

Cholesterol

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20
Q

DHEA is a precursor for ___ ______ synthesis

A

Sex hormone

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21
Q

Estrogen, testosterone and DHT are activated by?

A

DHEA binding and activating them

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22
Q

This hormone is an agonist of adrenergic receptors?

A

Epinephrine

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23
Q

Epinephrine causes physiologic effects known as the______ __ _______ response?

A

Fight or flight

  • Increased HR
  • Increased RR
  • Stim glycogenolysis & lipolysis
  • Muscle contraction
  • Vasoconstriction & Vasodilation
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24
Q

This hormone / neurotransmitter activates noradrenergic receptors and plays a role in fight or flight…

A

Norepinephrine

  • Increases arousal / alertness in brain
  • Help forming / retrieving memories
  • Increases restlessness / anxiety
  • Increase HR/BP
  • triggers glucose store release
  • increases blood flow to SM
  • decrease motility, urination, blood flow to GI
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25
Q

Overproduction of aldosterone by the adrenal cortex is what condition

A

Hyperaldosteronism

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26
Q

Classic findings of hyperaldosteronism

A
  • difficult to control HTN (HA, Vision impairment)
  • Hypokalemia (muscle weakness, polyruia)
  • Hypernatremia
  • metabolic alkalosis
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27
Q

Risk factor of hyperaldosteronism

A

Family Hx

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28
Q

True of False: Secondary hyperaldosteronism is more common than primary

A

False

Primary is more common

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29
Q

Condition in which one or both adrenal glands are hyperactive

A

Primary hyperaldosteronism

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30
Q

Causes of primary hyperaldosteronism

A
  • idiopathic
  • adrenal adenoma
  • adrenal carcinoma
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31
Q

____________ hyperaldosteronism is the overstimulation of adrenal glands to secrete aldosterone

A

Secondary hyperaldosteronism

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32
Q

Causes of secondary hyperaldosteronism

A
  • hyperkalemia
  • hyponatremia
  • hypotension
  • decreased renal perfusion
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33
Q

Conn’s Syndrome involves which hormone?

A

Aldosterone

34
Q

Cushing’s Syndrome involves which hormone?

A

Cortisol

35
Q

Hyperandrogenism involves which hormones?

This is a gimme!!

A

Androgens

36
Q

True or false: People with sever HTN that is able to be controlled with medications should be tested for hyperaldosteronism.

A

False

Severe or drug-resistant HTN

37
Q

True or false: someone with HTN while taking a high dose diuretics-induced hypokalemia should be tested for hyperaldosteronism.

A

False

HTN + spontaneous or low dose diuretic induced hypokalemia

38
Q

Patients with HTN +adrenal incidentaloma should / should not get tested for hyperaldosteronism?

A

Should get tested

39
Q

A patient with HTN that wife states snores very loudly. Tested or not tested for hyperaldosteronism?

A

Tested

HTN + sleep apnea

40
Q

Patients with HTN and FH of early -onset HTN / CVA, age <40 should……

A

Get tested for hyperaldosteronism

41
Q

T or F: All hypertensive 2nd degree relatives of someone with primary hyperaldosteronism should get tested?

A

False

1st degree relative

42
Q

Step one of diagnosing hyperaldosteronism?

A

Labs:
-Plasma aldosterone concentration (PAC) - will be high

-Plasma renin activity (PRA)

43
Q

In a PAC/PRA ratio what findings would you see for primary hyperaldosteronism?

A

Increased Aldosterone
&
Decreased Renin

44
Q

When a PAC/PRA ratio shows an increase in aldosterone AND Renin is this primary or secondary hyperaldosteronism?

A

Secondary hyperaldosteronism

45
Q

What is the treatment for hyperaldosteronism if a single adrenal gland is the cause?

A

Unilateral Laparoscopic adrenalectomy

46
Q

What is the treatment for hyperaldosteronism if there is bilateral adrenal gland involvement?

A

spironolactone (Aldactone)

side effects: hyperkalemia, gynecomastia, etc

47
Q

What is 2nd line treatment for hyperaldosteronism?

A

Eplerenone

Has fewer side effects but not as effective for HTN

Side effects: Hyperkalemia , Hypertriglyceridemia

48
Q

True or false: patients receiving treatment for hyperaldosteronism do not need close monitoring.

A

False

They need close monitoring of BP and BMP

49
Q

Mineralocorticoid excess can occur with the use of ________ in hyperaldosteronism so patients should avoid its use.

A

Tobacco

50
Q

What are some lifestyle changes patient with hyperaldosteronism can make?

A
  • regular exercise
  • low Na+ diets
  • maintain ideal body weight
51
Q

Condition caused by aldosterone deficiency or impairment of aldosterone function.

A

Hypoaldosteronism

52
Q

Risk factors for hypoaldosteronism

A
  • DM
  • Nephropathy
  • meds (NSAIDS, aldactone, haparin, B-blockers)
  • FH
53
Q

Most common cause of aldosterone deficiency / reduced production?

A

Renal disease

- diabetic nephropathy 
- NSAIDS use
54
Q

T of F: Spironolactone can cause a decreased response to aldosterone?

A

True:

as well as certain antibiotics (i.e. bactrim)

55
Q

Cause of pseudohypoaldosteronism?

A

Renal aldosterone receptors aren’t responsive to aldosterone

56
Q

What are the clinical features of hypoaldosteronism?

A
  • Often asymptomatic
  • Hyperkalemia
  • Mild hyperchloremic metabolic acidosis
57
Q

Diagnosis of hypoaldosteronism?

A 
BMP
    -Hyperkalemia
    - may see hyponatremia
    -Hyperchloremic metabolic acidosis 
    - may have increased BUN/CR2/2
Plasma renin activity, serum aldosterone
58
Q

In hypoaldosteronism low renin & low aldosterone indicates?

A

hyporeninemic hypoaldosteronism

59
Q

In hypoaldosteronism High renin & high aldosterone indicates?

A

End-organ is refractory to aldosterone

60
Q

in hypoaldosteronism High renin & low aldosterone indicates?

A

Adrenal gland abnormality

61
Q

Treatment for primary adrenal insufficiency?

A

Mineralocorticoid replacement therapy

- Fludrocortisone (Florinef)

62
Q

Treatment for Hyporeninemic Hypoaldosteronism?

A
  • Fludrocortisone (Florinef)

- Low K+ diet and/or loop or thiazide diuretics

63
Q

Adrenal Insufficiency is …

A

When the adrenal glands don’t produce enough cortisol and/or aldosterone

64
Q

T or F: Adrenal insufficiency is not life threatening?

A

False

It can be life-threatening

65
Q

Addison’s Disease is a_______ adrenal insufficiency.

A

Primary adrenal insufficiency

66
Q

Causes of Addison’s Disease

A
  • Autoimmune adrenalitis
  • genetic
  • infectious - TB, HIV, fungal
  • meds
  • Adrenal hemorrhage
  • Mets to adrenal gland
67
Q

Secondary adrenal insufficiency is caused by….

A

Lack of ACTH stimulation from pituitary

68
Q

Tertiary adrenal insufficiency is caused by…

A

Lack of CRH from hypothalamus

69
Q

T or F: Adrenal insufficiencies can be caused by abrupt WD of steroid treatments>

A

True

70
Q

Common clinical features of adrenal insufficiency

A
  • Weakness
  • Fatigue
  • GI symptoms
  • anorexia / weight loss
  • Hypotension
  • hypoglycemia
71
Q

Hyperpigmentation of the skin and mucous membranes due to increased ACTH can be seen in which type of adrenal insufficiency?

A 
Primary (Addison's disease)
also see 
-hyponatremia -->hypotension
-hyperkalemia
-salt cravings
72
Q

T or F: hyperpigmentation is seen in secondary adrenal insufficiency but not Tertiary.

A

False:

Only seen in primary

73
Q

T or F: Hypoglycemia is more common in secondary and tertiary adrenal insufficiency than in Addison’s ?

A

True

74
Q

clinical features of Adrenal crisis (Addisonian crisis)

A
  • Hypotension –>hypovolemic shock
  • may mimic acute abdomen
  • May have decreased LOC, stupor, coma
  • can be triggered by PA SCHOOL, or other stress, surgery, acute illness
75
Q

Dx for Adrenal insufficiency

A
  • BMP
    • -Hyperkalemia (primary)
    • -Hyponatremia
    • -hypoglycemia
  • Simplified cosyntropin test (ACTH stim test) is diagnostic
76
Q

Treatment for Acute Adrenal Insufficiency (Addisonian crisis)

A
  • aggressive IV fluids
  • Glucocorticoid replacement
    • -hydrocortisone or dexamethasoe
77
Q

T or F: you should wait for plasma cortisol levels before providing treatment.

A

False

don’t delay treatment while waiting for the plasma cortisol results

78
Q

T or F: People with adrenal insufficiency should avoid Sodium intake?

A

False

They can have liberal sodium intake

79
Q

Treatment for Primary Adrenal insufficiency

A
  • Mineralocorticoid replacement

- -Fludrocortisone + Hydrocortisone OR Prednisone

80
Q

T or F: A patient is never allowed to increase their glucocorticoid dose because this could be fatal!

A

False:

During illness or prior to surgery they should increase the dose

RRCCPA Clinical Medicine I (49 decks)

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