Adrenal Disorders Flashcards
does acute or chronic stimulation of adrenal lead to hypetrophy?
chronic
what is the precursor for all the hormones of the adrenal cortex?
pregnenolone
when is peak cortisol level?
usually 8am or right after patient wakes up
`what is not made in primary adrenal insufficiency?
no cortisol or aldosterone
what is the most common cause of primary adrenal insufficiency?
autoimmune
what is the most common cause of primary adrenal insufficiency in developing countries?
infections
what three bugs are common for primary adrenal insufficiency?
TB, HIV, histoplasmosis
what infiltrative diseases can cause primary adrenal insufficiency?
tumors, amyloid, sarcoid, hemachromacytosis
what heme issue can cause primary adrenal insufficiency?
spontaneous with disseminated intravascular coagulation
what drugs can cause primary adrenal insufficiency?
ketoconazole and rifampin
what does elevated ACTH breakdown lead to?
increased MSH
what can MSH cause in someone?
hyperpigmentation esp at skin folds and palms
what pituitary hormone is elevated in primary adrenal insufficiency?
ACTH
where does secondary adrenal insufficiency occur?
pituitary or hypothalamus
what features arise in primary adrenal insufficiency from low cortisol?
faitgue/weight loss hypotension abdominal pain hyponatremia hypoglycemia
what is most common non iatrogenic cause of secondary adrenal insufficiency?
pituitary or hypothalamic tumors
what is most common cause of secondary adrenal insufficiency?
iatrogenic from surgery or exogenou steroids
explain how glucocorticoid use can lead to secondary adrenal insufficiency?
prolonged glucos decreases ACTH and you get adrenal cortical atrophy…so then if you take them off quickly from the glucos they do not re make the adrenal quickly enough and get deficiency
what hormones are lost insecondary adrenal insufficiency?
only glucocorticoids..adosterone is still good
in secondary adrenal insufficiency what is hyponatremia from?
los of glucocorticoids
in primary adrenal insufficiency what is hyponatremi from?
both aldo and gluco loss
in secondary AI, when will you have falsely normal cortisol response to ACTH?
acute pituitary failure because the adrenal has not had time to atrophy
what is Rx for primary adrenal insufficiency loss of glucos?
hydrocortisone and prednisone
what activities does hydrocortisone have?
mineralocorticoid and gluococorticoid
what is Rx for primary adrenal insufficiency loss of aldos?
fludrocortisone or hydrocortisone
what do you have to do with cortisol rx for patients in stress? do you do this with aldos in stress?
need to double or triple the dose….do not do with aldos
what is rx for secondary AI?
glucocorticoid replacement…not mineralocorticoid…so prednisone and dexamethasone possible
what is the name for autoimmune primary adrenal insufficiency?
addisons disease
what is seen with skin in primary adrenal insufficiency?
ACTH increases and you get more melanin so hyperpigmentation
name the five features of primary AI from low cortisol
fatigue/weight loss hypotension abdominal pain hyponatremia hypoglycemia
what are features of low androgen in primary AI?
loss of pubic and axillary hair
what i the number one iatrogenic cause of secondary AI?
long term use of gluococoticoids
what is the cosynotropin stimulation test?
give ACTH and see if cortisol levels rise in the plasma
does secondary or primary AI respond better to the cosynotropin test?
secondary has higher rise in the cortisol
why do patients with secondary AI, despite making some cortisol, fail to produce normal amount in cosynotropin test?
adrenal has atrophied
what is inheritance of congenital adrenal hyperplasia?
AR
what is issue in congenital adrenal hyperplasia?
mutation in enzyme of adrenal steroid synthesis pathwya
what is most common enzyme deficiency in congenital adrenal hyperplasia?
21-hydroxylase
what is the first step in production of steroids in adrenal? what stimulates this?
cholesterol to pregnenolone
this is stimulated by ACTH
pregnenolone then becomes what in aldosterone formation?
progesterone
progesterone can lead to what two things in the steroid production in adrenal?
11-deoxycortisone and 17-OH progesterone
17-OH progesterone and progesterone are turned down the cortisol and aldosterone pathway respectively, but by what enzyme?
21-OHase
so in congenital adrenal hyperplasia when 21-OHase does not work, what cannot be made? what is there excess of?
cortisol and aldo cant be produced and androgens are overproduced
if you have severe cortisol deficiency in 21-OHase what happens?
vascular collapse, vomiting death
androgen excess in 21-OHase deficiency leads to what?
masculinization of external genitalia in female infants and hirsutism
what enzyme is in charge of turning 11-deoxycorticosterone and 11-deoxycortisol into aldo and cortisol respictively?
11-hydroxylase
what builds up in 11-hydroxylase deficiency?
11-dexoycortisone and androgens
what is role of 11-deoxycortisone?
can actually act as a weak mineralocorticoid…so it leads to hypertension
