Adrenal disorders: Howell

Question 1

Incidence and etiology of addisons disease

Answer 1

-insidious onset, progressive
- 80% due to idiopathic (AI) atrophy of adrenal cortex
- other: granulomatous infections, necrosis

Question 2

pathogenesis of addisions disease

Answer 2

-primary hypofunction of adrenal gland
- lack of aldosterone: hyponatremic, hyperkalemia, dehydration
-lack of cortisol: hypoglycemia, myocardial weakness, hyperpigmentation
-lack of androgens: lack of pubic and axillary hair in females

Question 3

Signs and sx of addison’s disease

Answer 3

• H/A, nausea and vomit, malaise, anorexia
  -increased skin pigmentation (especially at creases)
  -orthostatic hypotension
  -decreased cold tolerance
  -fatigue, weakness
  depression
  wt loss and dehydration in later stages

Question 4

what sx of addisons dz can occur at later stages

Answer 4

weight loss and dehydration

Question 5

signs and sx of addisonian crisis

Answer 5

sudden onset:

-hyperpyrexia
-severe v/d
-severe abdominal and low back pain
-peripheral vascular collapse
-cyanosis
-confusion

Question 6

Diagnostic labs in addison’s disease

Answer 6

-hyponatremia
-hyperkalemia
-metabolic acidosis: as potassium increases in the blood, hydrogen ions increase as well
-increased renin and ACTH levels: renin due to decrease in aldosterone
-morning cortisol levels will be low

Question 7

what is the most common cause of cushings syndrome

Answer 7

prolonged or high doses of exogenous corticosteroids

Question 8

which cushing’s etiology is more common in women

Answer 8

endogenous causes 5X more common in women
(pituitary adenoma secreting ACTH)

Question 9

cushings syndrome vs disease

Answer 9

syndrome: group of signs and symptoms

disease: pituitary adenoma

Question 10

signs and sx of cushings

Answer 10

-impaired collagen production: spontaneous bruising, poor wound healing, purple striae over abdomen

• proximal muscle weakness
  -bone loss
  -hyperglycemia
  -hypertension
  -increased central fat deposit

Question 11

dx labs for cushings

Answer 11

-electrolytes: ACTH issue? normal electrolyses, adrenal adenoma? abnormal electrolytes

• elevated serum and 24 hour urinary cortisol levels

Question 12

ddx pituitary adenoma and SCC lung

Answer 12

dexa suppression test:
-give dexametha(cortisonic) and look at response of ACTH
-If pituitary adenoma: ACTH goes down 50% bc its bening and responds to higher cortisol

-if SCC of lung: no change bc cancer is rogue and does what it wants

Question 13

Secondary adrenal insufficiency etiology

Answer 13

-Sheehans syndrome
-tumors, trauma
-discontinuation of exogenous steroids

Question 14

Signs and sx of secondary adrenal insufficiency

Answer 14

• similar to addisons dx however there is no hyperpigmentation (low ACTH)

Question 15

DX of secondary adrenal insufficiency

Answer 15

-electrolytes and aldosterone will be normal (not under control of ACTH)
-ACTH stimulation test results in increase cortisol levels

Question 16

another name for primary hyperaldosteronism

Answer 16

conn syndrome

Question 17

sx of conn syndrome

Answer 17

• muscle weakness
• palpitation, HTN
  -H/A
  -fatigue
  -metabolic alkolosis

Question 18

incidence of conn syndrome

Answer 18

2x more common in women

Question 19

dx labs for conn syndrome

Answer 19

• hypokalemia
  -hypernatremia
  -aldosterone to renin ratio greater than 20:1
  -normal ACTH and glucose
  -abdominal CT scan for adenoma : distinguishes hyperplasia from primary hyperaldosterone

Question 20

Etiology of conn syndrome

Answer 20

50% due to unilateral adenomas
40% due to bilateral hyperplasia

Question 21

etiology of secondary hyperaldosteronism

Answer 21

stimulation by renin-angiotensin system (not adrenal gland)

-CHF
-liver cirrhosis
-nephrotic syndrome

Question 22

sx of secondary hyperaldosteronism

Answer 22

symptoms similar to primary but more HTN and edema

Question 23

pheochromocytoma incidence

Answer 23

adrenal medulla disorder
-rare
-young adults 20-40 yrs old
-95% are bening tumors

Question 24

what is pheochromocytoma assocaited with

Answer 24

men II

Question 25

sx of pheochromocytoma

Answer 25

• tremors, nervousness, H/A, sweating
  -HTN, palpitations, tachycardia

may be episodic

Question 26

dx of pheochromocytoma

Answer 26

• 24 hour urine for catecholamines and metabolites
  -CT or MRI of the adrenal medulla

Question 27

inheritance pattern in congenital adrenal hyperplasia

Answer 27

autosommal recessive

Question 28

pathogenesis of congenital adrenal hyperplasia

Answer 28

21-hydroxylase deficiency in over 90% of cases
unable to make cortisol and aldosterone —- precursors shift to androgen synth

Question 29

severe sx of congenital adrenal hyperplasia

Answer 29

-virilization of female genital
-V/D, dehydration
-failure to thrive, salt wasting
- accelerated skeletal and pubertal maturation in males (lead to short stature bc growth plates close early in age)

Question 30

mild sx of congenital adrenal hyperplasia

Answer 30

-hirsutism
-oligomenorrhea
-infertility
-acne
-orthostatic hypotension
-frequent illness
-poor response to stress

Question 31

labs congenital adrenal hyperplasia

Answer 31

-hyponatremia
-hyperkalemia
-metabolic acidosis
-low aldosterone
low cortisol
hypoglycemia