Adrenal disorders

Question 1

Causes of primary adrenal insufficiency

Answer 1

AI adrenalitis, TB, amyloidosis, hemochromatosis, bilateral adrenalectomy, adrenal vein thrombosis, adrenal artery embolus, metastatic carcinoma

Question 2

Causes of secondary adrenocortical insufficiency

Answer 2

hypopituitarism (sheehan, chromophobe adenoma, hypophysectomy) Optic gliomas, craniopharyngiomas, basal meningitis, stalk section, tumors of 3rd ventricle, encephalitis, trauma, corticosteroid administration

Question 3

What symptoms should you look for in chronic adrenal insufficiency?

Answer 3

1. weakness
2. pigmentation of skin and mucous membranes
3. Weight loss
4. hypotension
5. Anorexia, N/V
6. Salt craving
7. Syncopal episodes
8. Vitiligo

Question 4

What symptoms should you look for in acute adrenal insufficiency?

Answer 4

1. hypotension
2. N/V
3. Collapse
4. Hyperthermia
5. Hypoglycemia
6. Hyponatremia, hyperkalemia

Question 5

What are causes of ACTH-dependent Cushing’s syndrome?

Answer 5

Cushing’s disease, ectopic ACTH syndrome, ectopic CRH syndrome

Question 6

ACTH independent cushings syndrome causes

Answer 6

adrenal adenoma, adrenal carcinoma, micronodular hyperplasia, macronodular hyperplasia

Question 7

Causes of pseudo-cushincs syndrome

Answer 7

major depressive disorder, alcoholism

Question 8

Biochemical tests for presence or absence of cushing’s syndrome.

Answer 8

Circardian rhythm or plasma cortisol, low dose dexamethasone suppression, 24 hr urinary free cortisol, salivary cortisol determination

Question 9

What test differentiates patients with Cushings syndrome of any cause from pt who do not have Cushings.

Answer 9

Low dose- dexamethasone

Question 10

What biochemical tests are used for etiology of established Cushings?

Answer 10

high dose dexamethasone suppression. Plasma ACTH immunoassay, metyrapone test, CRH stimulation +/- petrosal sinus cath

Question 11

Describe what a dexamethasone distinguishes between and how.

Answer 11

Pt with cushings disease from pt with ectopic ACTH syndrome and from those with adrenal tumors producing excess cortisol. This is because a pituitary tumor producing ACTH will usually respond to exogenous GC if a high enough dose is give.

Question 12

What will happen with pt with Cushing’s disease in a high dose dexamethasone test

Answer 12

suppress

Question 13

More than half of all pt require only 3 tests to determine that they have cushings disease:

Answer 13

24 hour urine cortisol, measurement of plasma cortisol and ACTH, high dose dex suppression test