Adrenal Disorders Flashcards
Differentiate between
(11) - VS (3) - VS (21) hydroxylase.
In BP
All No cortisol - high androgen
Differentiate between
(11) - VS (3) - VS (21) hydroxylase.
In veralization
All no cortisol - high androgen
Which type of CAH has high aldosteroene?
Defect in 17 alfa hydroxylase enzyme
Name the defect in each [21] [17] [11] [3]
- No aldosterone, cortisol - yes androgen
- No cortisol, androgren - yes aldosterone
- No cortisol - yes androgen, deoxycortison
- No aldosterone, cortisol - yes DHEA
Which type of CAH has high deoxyxortison?
11
Which type of CAH has high DHEA?
3
What is the most common cause of primary adrenal insufficency?
Conginital adrenal hyperplasia
What is the CRH, ACTH, and cortisol level of primary adrenal insufficency?
High CRH, ACTH and low cortisol
What is the clinical presentation of primary AI?
- non-specific: abdominal pain, slow growth, Fatigue, nausea, weakness, headache
- salt wasting symptoms: dehydration, hypotension, weight loss, salt craving
- low cortisol symptoms: hypoglycemia
- high ACTH symptoms: hyperpigmentation
What are the symptoms present in primary AI with salt wasting?
- dehydration, weight loss, lethargy
- hyponatermia\hyperkalemia, hypoglycemia
What is adrenal crisis?
Gradual hypotension or shock
- high renin activity
- low aldosterone secretion
Where’s the lesion in
- primary AI
- secondary AI
- tertiary AI
- adrenal cortex
- pituitary
- hypothalamus
What is the CRH, ACTH, and cortisol level of secondary adrenal insufficency?
Low ACTH, CRH, cortisol
Differentiate between primary and secondary AI?
Secondary don’t have:
- High acth: no pigmentation
- high aldosterone: no dehydration etc.
Both have: hypoglycemia.
When is AI has more pronounced hypoglycemia?
In secondary which may be combined with growth hormone deficiency
What is the most definitive test for AI?
Serum cortisol levels
Morning cortisol <3
Positive adrenal autoantibodies can help you identify which adrenal disorder?
Addison’s
What test to orders when suspecting CAH in newborn?
“Either due to ambigous genetalia or salt wasting”
- random cortisol studies
- random androgen studies
- dynamic testing of HPA axis by ACTH stimulation test
How to treat
- primary AI:
- secondary AI:
- glucocorticoid & mineralocorticoid
- cortisol
When to give supaphysiological dose of hydrocortisone?
In CAH to supress adrenal androgens
Define the following:
- clitoromegaly
- hypospadia
- labioscrotal fusion
- micophallus:
- posterior fusion
- enlargement of clitoris
- opening of uretheral other than the tip of the penis
- fusion of labia
- phallus less than 2.5
- fusion of labia at posterior aspect near anus
Criteria for suspecting DSD
In newborn\infant
- discordance between genital appearance and prentalal karyotype
- overt ambiguity can’t be determined (cloacal exstrophy)
- F genetalia: + enalrged clitoris\posterior labial fusion
- M genetalia + bilateral undecendant tstes\ hypospadia\ micropenia
What’s the criteria for suspecting DSD in older childre
- previously unrecognized genital ambiguity
- inguinal hernia in a girl
- delayed or incomplete puberty
- primary amenorrhea or virilization
- breast development in boy
- hematuria in boy with suprapubic mass (hemaatocolpos) with breast enlargment after puberty in boy with hypospadia\undescended gonads
How is the fetal genital development in the first and second trimester?
First: testosterone under HCG control
Second\3rd: pituitary gonadotropins
