Adrenal Disorders Flashcards by Soliman Oushy

Causes of primary adrenal insufficiency

Autoimmune: Addison's
infectious: TB, FUngi. HIV
Infiltrative: Amyloid
Hemorrhage
Metastatic
Metabolic
Surgery

How well did you know this?

Not at all

Perfectly

Unique findings in primary adrenal insufficincy

Vitiligo
pigmintation
hyperkalemia

How well did you know this?

Not at all

Perfectly

Lab findings in Primary adrenal insufficincy

Hyperkalemia 
Low serum cortisol 
High serum ACTH
Small on CT: metabolic/autoimmune
Big on CT: all other

How well did you know this?

Not at all

Perfectly

Agent used in ACTH stimulation test

cpsyntropin (synthetic ACTH)

How well did you know this?

Not at all

Perfectly

Components of Autoimmune Polyglandular Syndromes (APS-1)

Adrenal Insufficiency
hypoparathyroidism
DM1
mucocutanous candidiasis

How well did you know this?

Not at all

Perfectly

Components of Autoimmune Polyglandular Syndromes (APS-2)

Adrenal Insufficiency
hypothyroidism
DM1

How well did you know this?

Not at all

Perfectly

Causes of secondary adrenal insufficiency

-Glucocorticoids (most common)
-opioids
-tumor
-surgery
Problem with Hypothalamic CRH or pituitary ACTH

How well did you know this?

Not at all

Perfectly

LAb findings in secondary adrenal insufficiency

Low serum cortisol
Cosyntropin stimulation test accurate if AI>3 weeks
normal or low ACTH
You want to image the pituitary not the adrenalgland

How well did you know this?

Not at all

Perfectly

Adrenal insufficiency Tx

Primary or secondary: Glucocorticid replacement

- Primary only: Mineralocorticoid replacement

How well did you know this?

Not at all

Perfectly

Subtypes of primary aldosteronism

Aldosterone producing adenoma (APA)
Idiopathic Hyperaldosteronism (IHA) ( more common)

How well did you know this?

Not at all

Perfectly

Sx of primary aldosteronism

Hypertension
Hypokalemia
Metabolic Alkolosis

How well did you know this?

Not at all

Perfectly

Who to screen for primary aldosternoism

hypokalemia (provoked w/ diurtics or spontaneous)

-Hypertension

How well did you know this?

Not at all

Perfectly

Labs for Primary aldosternoism

Morning sample:
-Plasma aldosterone
-Plasma Renin Activity
Run confirmation tests for a positive screen (try to supress aldosterone)
-Sodium supression testing (oral salt load or IV saline infusion)
Diagnostic results:
-Oral salt load (24 hr urine aldosterone >12
-IV saline (PA>10)

How well did you know this?

Not at all

Perfectly

Best imaging tests for adrenal

CT (best)

How well did you know this?

Not at all

Perfectly

Imaging of adrenal hyperplasia vs adenoma

Hyperplasia 
-enlarged
-same shape
-can be multinodular
Adenoma
-oval mass

How well did you know this?

Not at all

Perfectly

Explain NP-59 adrenaocortical scintigraphy

NP-59: cholesterol analog -binds to adrenal LDL
receptors (cholesterol is base for steroid hormones)
-Adenoma:Unilateral Visualization
-Hyperplasia:Bilateral Visualization Sensitivity: 50-100%

APA is llikely found in pts w/

Age <40
Severe HTN
Severe Hypokalemia
High PA
High urine aldosterone

APA Tx

Pre-op: Aldosterone antagonists

Spironolactone
`Eplerenone

THEN
operate: laproscopic/open

Pheochromocytoma Sx (triad)

-Hypertension Plus
-Headaches,
-Sweating,
-Palpitations
Prevalence is low (1/1,000-10,000 of HTN pts)

Rule of 10’s pheochromocytoma

10% Malignant
10% Familial
10% Bilateral
10% extra-adrenal

Pheocromocytome familial disease

Multiple Endocrine Neoplasia Type 2A/2B
Von Hippel Lindau Syndrome
Neurofibromatosis Type 1
Familial Paragangliomas (SDH Mutations)

Pheochromocytoma screening tests

Urine metanephrins (best fr screening)
urine catecholamines (best for screening)
plasma metanephrines (use for pts w/ high pretest probability)

Pheochromocytoma radiology

spherical, well circumscribed

variable features on CT

Organ of Zuckerkand

Sympathetic chain ganglia at the aortic bifurcation

Pre-op management of pheochromocytoma

``` Alpha blockers (1st) Beta blockers (2nd-after alpha blockade) CCB (alone)\ ``` then take it out

T or F: 80% of cushing syndrome is caused by ACTH secreting tumor

True

T or F: 10% of Cushing's is caused by cortisol secreting adrenal tumor

True, the other 10% is ectopic ACTH secreting tumor.

Cushing's presentation

Santa Clause (Sx covered in other lectures)

Screening for Cushing's

24 Hr urine cortisol (elevated) 1 mg dexamethazone supression test (DST) Bedtime salivary cortisol (elevated)

Conditions with hypercortisolism but NOT cushings

``` Pregnancy Depression Alcoholism \Morbid Obesity Diabetes Mellitus, Poorly Controlled ```

Tests to localize Cushing's cause

Pituitary MRI Chest CT Abdominal CT Inferior Petrosal Sinus Sampling

Cushing's Tx

- Surgery: - ACTH Secretion Inhibitors: Cabergoline, Pasireotide -Cortisol Synthesis Inhibitors: Ketoconazole, Metyrapone, Etomidate - Adrenolytic Agents: Mitotane - Cortisol Receptor Blockers: Mefispristone

What are adrenal incidentaloma

Incidental finding of adrenal tumor (frequent finding) Usually benign usually non-functional (bu some secrete unregulated cortisol)

Evaluation of incidentalomas

Determine cancer risk | determine if hormonally active

Management of incidentalomas

``` Surgical Removal -Size >4.5 cm -Progressive Growth -Hormone Secretion Monitor (6 mos, 12 mos, 24 mos) -Size < 4.5 cm -No Hormone Secretion ```