Adrenal Disorders

Question 1

Hypercortisolism can be used interchangeably with the term

Answer 1

Cushing syndrome

Question 2

Cushing disease meaning

Answer 2

pituitary overproduction of ACTH

Question 3

Hypercortisolism can also be from the ectopic production of ACTH from
_________ or from overproduction_______.

Answer 3

carcinoid or cancer

autonomously in the adrenal gland

Question 4

Etiology of Hypercortisolism

Answer 4

Pituitary ACTH (Cushing disease) 70%
Adrenals 15%
Ectopic ACTH (cancer, carcinoid) 10%
Unknown source of ACTH 5%

Question 5

men and woman particular cxfx of Hypercortisolism

Answer 5

Osteoporosis
Menstrual disorders in women
Erectile dysfunction in men

Due to inhibition of calcitriol synthesis by cortisol

Hypercortisolism results in inhibition of gonadotropin release

Question 6

renal cxfx of Hypercortisolism

Answer 6

Polyuria: from hyperglycemia and increased free water clearance

Question 7

neurological cxfx of Hypercortisolism

Answer 7

Cognitive disturbance: from decreased concentration to psychosis

Question 8

Hypercortisolism the 2 Dx phases

Answer 8

1. Establish the Presence of Hypercortisolism

2. Establish the Cause of Hypercortisolism

Question 9

Hypercortisolism best initial test

Answer 9

24- hour urine
cortisol.
If this is not in the choices, then the answer is the 1 mg overnight
dexamethasone suppression test. THO this can give false +

“Low then high” low=low dose dexa supp. ACThen

Question 10

The 1 mg overnight dexamethasone
suppression test should normally ______. If this
______ occurs, hypercortisolism can be excluded.

Answer 10

suppress the morning cortisol level

suppression

Question 11

Causes of false positive 1 mg overnight suppression testing:

Answer 11

Depression
Alcoholism
Obesity

Question 12

best initial test to determine the cause (source) or location of hypercortisolism

Answer 12

ACTH
Decreased ACTH level = adrenal source

ACTH level is elevated, the source could be from:
Pituitary (suppresses with high dose dexamethasone)
Ectopic production: lung cancer, carcinoid (dexamethasone does not
suppress)

Question 13

You must always confirm the source of hypercortisolism with ______before you perform imaging studies. and why

Answer 13

biochemical tests

At least 10% of the population has an abnormality of the pituitary on
MRI. If you start with a scan, you may remove the pituitary when the
source is in the adrenals.

Question 14

Once the ACTH level is elevated and does not suppress with high dose
dexamethasone, what to do?

Answer 14

scan the brain with an MRI.

Question 15

what to do if If the MRI does not show a clear

pituitary lesion,

Answer 15

sample the inferior petrosal sinus for ACTH, possibly after

stimulating the patient with corticotropin-releasing hormone (CRH).

Question 16

An elevated ACTH from the venous drainage of the pituitary ______the pituitary as the source.

Answer 16

confirms

Question 17

The petrosal venous sinus must be sampled because

Answer 17

some pituitary lesions are too small to be detected on MRI

Question 18

If the ACTH is elevated, and you cannot find a defect in the pituitary either by MRI or by sampling the petrosal sinus, what to do

Answer 18

scan the chest looking for an ectopic source of ACTH production.

Question 19

Effects of hypercortisolism over
glicemia
lipids
K
pH
Leukocytes

Answer 19

Hyperglycemia
Hyperlipidemia
Hypokalemia
Metabolic alkalosis
Leukocytosis from demargination of white blood cells

Question 20

why is there Hypokalemia and metabolic alkalosis in hypercortisolism

Answer 20

there is some
aldosteronelike effect of cortisol that has an effect on the kidney’s distal tubule
of excreting potassium and hydrogen ions.

Question 21

Hypercortisolism Tx

Answer 21

Surgically remove the source of the hypercortisolism

Question 22

what kind of Qx treat Hypercortisolism

Answer 22

Transsphenoidal surgery
is done for pituitary sources
aparoscopic removal is done for adrenal
sources

Question 23

what to do if Qx unsuccessful to treat Hypercortisolism

Answer 23

use pasireotide, which is a somatostatin
analog.

Pasireotide controls unresectable pituitary ACTH overproduction.

Question 24

When hypercortisolism cannot be cured with surgery, give

Answer 24

mifepristone.

Mifepristone inhibits cortisol receptors throughout the body.

Question 25

When adrenal
cancer cannot be fully resected or there is metastatic disease that can’t be
identified, give

Answer 25

mitotane.
an inhibitor of steroidogenesis that is also cytotoxic to adrenal tissue.

Mitotane cleans up adrenal cancer mets!