Adrenal disorders Flashcards
what is produced in the zona glomerulosa
mineralocorticoid production (aldosterone)
what is made in the zone fasciculata
glucocorticoid production
what is made in the zona reticularis
androgen production( testosterone, important in female sexuality)
what is made in the medulla
catecholamines(epinephrine,norepeinephrine,dopamine)
what does alodsterone stimulate and what is its goal
stimulated ronal tubule sodium reabsorption and potassium excretion.
The goal is to increase intravascular volume
what is the function of cortisol
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
what is the most common cause of Addison’s disease
autoimmune destruction of adrenal cortex
what are signs and symptoms associated with addisons disease
weakness, fatigability, low grade fever
hyperpigmentation
anorexia, weight loss, abdominal pain, salt craving, dehydration, hypotension, myalgias, arthralgias, delayed deep tendon reflexes, lethargy, confusion
What do labs look like in a person with Addison’s
hypoglycemia, plasma ACTH is elevated, low serum sodium, elevated potassium
How is it diagnosed?
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
how is chronic Adrenocortical insufficiency treatment
replacement of glucocorticoids and mineralocorticoids
hydrocortisone
DHEA
medical alert bracelet
what is the cause of adrenal crisis
occurs in patients who stop their steroidal medications
when else can an adrenal crisis happen
occur in stressful periods without prior glucocorticoid dose adjustment: infection, trauma, surgery
what is the goal of treatment with adrenal crisis?
revers hypotension and electrolyte abnormalities
IV- isotonic normal saline
replace glucocorticoids
what is the definition of cushing’s disease
causes by excess secretion of ACTH by a pituitary adenoma
what is the most common cause of endogenous hypercortisolism
cushings disease
what is the cause of cushing’s syndrome
adrenocortical tumors
non-pituitary ACTH secreting tumors
Ectopic CRH
chronic exposure to glucocorticoids hormones such a prednisone
what are the signs and symptoms of cushings syndrome
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
what does 24 hour urinary free cortisol level look like
levels high in cushings disease in 3 separate collections
what does the salivary cortisol level look like in cushings
high but normally it should be low
when performing low dose dexamethasone suppression test what will cortisol levels look like
the cortisol gets checked at 8am and will diagnose cushings if cortisol is high >0.5 mcg/dl
what does high dose dexa supression test differentiate between
cushings syndrome or disease
What will the cortisol levels look with with the dexa supression test?
cushings disease is harder to suppress with low dose dexa
adrenal adenomas and ectopic ACTH tumors do not respond to high dexa test
what is the treatment for cushings id caused by long term use of glucocorticoids hormones
the dosage is gradually reduced to the lowest dose adequated for control of the indicated disorder
what is the treatment for adenoma, adrenal adenoma
surgery
what are the complications with cushings
untreated can cause death
complications of hypertension and diabetes
increased susceptibility to infections
osteoporosis, nephrolithiasis, psychosis
what is pheochromocytoma
excessive catecholamine secreted from a tumor in the adrenal medulla
what are the signs and symptoms of pheochromocytoma
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
who should be screened for a pheochromocytoma
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
what type of labs would you want to do on a patient with pheocromocytoms
urinary catecholamines, total and fractionated metanephrines, vanillylmandelic acid and creatinine
direct plasma assay
what is the treatment for pheochromocytoma
surgical removal of tumor or adrenal gland
