Adrenal disorders

Question 1

what is produced in the zona glomerulosa

Answer 1

mineralocorticoid production (aldosterone)

Question 2

what is made in the zone fasciculata

Answer 2

glucocorticoid production

Question 3

what is made in the zona reticularis

Answer 3

androgen production( testosterone, important in female sexuality)

Question 4

what is made in the medulla

Answer 4

catecholamines(epinephrine,norepeinephrine,dopamine)

Question 5

what does alodsterone stimulate and what is its goal

Answer 5

stimulated ronal tubule sodium reabsorption and potassium excretion.
The goal is to increase intravascular volume

Question 6

what is the function of cortisol

Answer 6

inhibits insulin
regulated metabolism of proteins, carbs, fats
highest at 6am lowest at 12 (diurnal pattern)
increases with exercise and stress
increases in trauma, infection
required for angiotensin II prod

Question 7

what is the most common cause of Addison’s disease

Answer 7

autoimmune destruction of adrenal cortex

Question 8

what are signs and symptoms associated with addisons disease

Answer 8

weakness, fatigability, low grade fever
hyperpigmentation
anorexia, weight loss, abdominal pain, salt craving, dehydration, hypotension, myalgias, arthralgias, delayed deep tendon reflexes, lethargy, confusion

Question 9

What do labs look like in a person with Addison’s

Answer 9

hypoglycemia, plasma ACTH is elevated, low serum sodium, elevated potassium

Question 10

How is it diagnosed?

Answer 10

low plasma cortisol at 8am is diagnostic with elevated plasma ACTH level >200pg/ml
anti-adrenal antibodies in autoimmune disease
corticotropin stimulation test failed adrenal response is confirmatory

Question 11

how is chronic Adrenocortical insufficiency treatment

Answer 11

replacement of glucocorticoids and mineralocorticoids
hydrocortisone
DHEA
medical alert bracelet

Question 12

what is the cause of adrenal crisis

Answer 12

occurs in patients who stop their steroidal medications

Question 13

when else can an adrenal crisis happen

Answer 13

occur in stressful periods without prior glucocorticoid dose adjustment: infection, trauma, surgery

Question 14

what is the goal of treatment with adrenal crisis?

Answer 14

revers hypotension and electrolyte abnormalities
IV- isotonic normal saline
replace glucocorticoids

Question 15

what is the definition of cushing’s disease

Answer 15

causes by excess secretion of ACTH by a pituitary adenoma

Question 16

what is the most common cause of endogenous hypercortisolism

Answer 16

cushings disease

Question 17

what is the cause of cushing’s syndrome

Answer 17

adrenocortical tumors
non-pituitary ACTH secreting tumors
Ectopic CRH
chronic exposure to glucocorticoids hormones such a prednisone

Question 18

what are the signs and symptoms of cushings syndrome

Answer 18

central obesity
supraclavicular fat pads, protuberant abdomen
hypertensionm decreased glucose tolerance
amenorrhea, weakness
potassium excretion and NA retention and Ca loss
immunosupression
Hirsutism, osteoporosis, thirst, polyuria, renal calculi, acne, purple striae, impaired wound healing, susceptible to infections

Question 19

what does 24 hour urinary free cortisol level look like

Answer 19

levels high in cushings disease in 3 separate collections

Question 20

what does the salivary cortisol level look like in cushings

Answer 20

high but normally it should be low

Question 21

when performing low dose dexamethasone suppression test what will cortisol levels look like

Answer 21

the cortisol gets checked at 8am and will diagnose cushings if cortisol is high >0.5 mcg/dl

Question 22

what does high dose dexa supression test differentiate between

Answer 22

cushings syndrome or disease

Question 23

What will the cortisol levels look with with the dexa supression test?

Answer 23

cushings disease is harder to suppress with low dose dexa

adrenal adenomas and ectopic ACTH tumors do not respond to high dexa test

Question 24

what is the treatment for cushings id caused by long term use of glucocorticoids hormones

Answer 24

the dosage is gradually reduced to the lowest dose adequated for control of the indicated disorder

Question 25

what is the treatment for adenoma, adrenal adenoma

Answer 25

surgery

Question 26

what are the complications with cushings

Answer 26

untreated can cause death
complications of hypertension and diabetes
increased susceptibility to infections
osteoporosis, nephrolithiasis, psychosis

Question 27

what is pheochromocytoma

Answer 27

excessive catecholamine secreted from a tumor in the adrenal medulla

Question 28

what are the signs and symptoms of pheochromocytoma

Answer 28

hypertension
classic triad- severe headache, palpitations, profuse sweating and range from monthly to multiple episodes
cardiac arrythmias
intracerebral hemorrhage
hypertensive encephalopathy,epigastric pain, weakness, constipation, heart failure

Question 29

who should be screened for a pheochromocytoma

Answer 29

pateints with difficult to control hypertension
pts requiring more than 4 blood pressure meds
patients with onset of HTN before 35yo or after the age of 60

Question 30

what type of labs would you want to do on a patient with pheocromocytoms

Answer 30

urinary catecholamines, total and fractionated metanephrines, vanillylmandelic acid and creatinine
direct plasma assay

Question 31

what is the treatment for pheochromocytoma

Answer 31

surgical removal of tumor or adrenal gland