Adrenal Disorders

Question 1

Primary adrenal insufficiency results in loss of _________.

Answer 1

cortisol and aldosterone secretion

Question 2

Secondary adrenal insufficiency results in loss of _____________.

Answer 2

cortisol only (aldosterone is preserved because it’s controlled by angiotensin II)

Question 3

_____________ is also called autoimmune adrenalitis.

Answer 3

Addison’s disease

Question 4

What five drugs can cause adrenal insufficiency?

Answer 4

Aminoglutethimide 
Ketoconazole
Etomidate
Rifampin
Phenytoin

Question 5

The most common cause of primary adrenal insufficiency is ____________ and secondary adrenal insufficiency is _____________.

Answer 5

Addison’s disease; steroid use

Question 6

Salt craving is a symptom of ___________ adrenal insufficiency.

Answer 6

primary (because aldosterone secretion is preserved in secondary adrenal insufficiency)

Question 7

Adrenal crisis should be treated with ____________.

Answer 7

stress-dose steroids (100 mg every eight hours)

Question 8

What three signs and symptoms occur only in primary adrenal insufficiency (as opposed to secondary)?

Answer 8

Hypotension
Hyperkalemia
Hyponatremia

Question 9

Why does hyperpigmentation occur in primary adrenal insufficiency?

Answer 9

Because melanocyte-stimulating hormone and proopiomelanocortin are both breakdown products of POMC. If POMC is not broken down by the adrenal gland, then more is available to the melanocytes.

Question 10

Half of the people with Addison’s disease have at least _________________.

Answer 10

one other autoimmune disease

Question 11

What cortisol levels –taken around 7 - 8 AM –suggest adrenal insufficiency?

Answer 11

Partial: 5 - 16 mg/dL
Complete: less than 5 mg/dL

Question 12

If a person has suspiciously low cortisol levels, what should you do?

Answer 12

A cosyntropin test; less than 20 mg/dL 30-60 minutes after administration suggests adrenal insufficiency

Question 13

In primary adrenal insufficiency, you need to replace ______________, while in secondary adrenal insufficiency you only need to replace ___________.

Answer 13

both glucocorticoids and mineralocorticoids; glucocorticoids

Question 14

What is AVS?

Answer 14

Adrenal vein sampling

Question 15

Licorice intake can lead to _______________.

Answer 15

pseudohypercortisolism

Question 16

Plasma metanephrines should be drawn after ______________.

Answer 16

twenty minutes’ rest

Question 17

The vast majority of adrenal incidentalomas are ______________.

Answer 17

non-functional

Question 18

Cortisol is necessary for ____________ balance.

Answer 18

cardiovascular (in adrenal insufficiency, people get hypovolemia and hypotension)

Question 19

The most common cause of primary adrenal insufficiency in the U.S. is ___________, while worldwide it is ______________.

Answer 19

Addison’s (autoimmune destruction); TB

Question 20

The best way to diagnose adrenal insufficiency is _____________.

Answer 20

Cortrosyn stimulation; you measure cortisol 30 minutes and 60 minutes after administering Cortrosyn (synthetic ACTH). Levels greater than 20 ug/dl indicate adequacy of adrenal reserves

Question 21

The most common cause of primary hyperaldosteronism is ___________, followed by _____________.

Answer 21

idiopathic; adrenal adenoma

Question 22

These clinical signs should raise suspicion for primary hyperaldosteronism: _______________.

Answer 22

treatment-refractory hypertension, hypokalemia, and young age at onset

Question 23

The best diagnostic for primary hyperaldosteronism is a ___________ test.

Answer 23

aldosterone suppression (in which saline is given and then aldosterone levels measured)

Question 24

What differentiates MEN 2A and MEN 2B?

Answer 24

Both are mutations in the ret gene and present with pheochromocytoma and medullary thyroid carcinoma, but 2A presents with hyperparathyroidism (which has two A’s) while 2B presents with mucosal neuromas.

Question 25

What triad of symptoms does pheochromocytoma present with?

Answer 25

Diaphoresis, palpitations, and headaches

Question 26

The preferred lab test for diagnosing pheochromocytoma is _______________.

Answer 26

24-hour urine metanephrines

Question 27

The most common cause of Cushing’s is iatrogenic, but the second most common cause is ________________.

Answer 27

ACTH-secreting adenoma

Question 28

________________ is also called Conn’s syndrome.

Answer 28

Primary hyperaldosteronism

Question 29

Why does licorice cause pseudohyperaldosteronism?

Answer 29

Licorice inhibits the enzyme that converts cortisol to cortisone, thereby raising the levels of cortisol. This binds to the aldosterone receptor and leads to similar symptoms of high aldosterone levels.

Question 30

Metyrapone is a __________________.

Answer 30

cortisol synthesis inhibitor

Question 31

What can affect metanephrine level?

Answer 31

Acetaminophen, SSRIs, marijuana, and SNRIs

Question 32

In addition to metanephrines, ______________ is another good lab indicator of pheochromocytoma.

Answer 32

vanillylmandelic acid

Question 33

About half of pheochromocytomas are __________.

Answer 33

hereditary (more if the presentation occurs in childhood)

Question 34

Which chromosome does the Ret gene lie on?

Answer 34

10 (MEN = ten)

Question 35

What is a good way on imaging to predict an adrenal adenoma’s prognosis?

Answer 35

Houndsfield units: less than 10 is suggestive of benign