Adrenal disorders: Howell Flashcards
Incidence and etiology of addisons disease
-insidious onset, progressive
- 80% due to idiopathic (AI) atrophy of adrenal cortex
- other: granulomatous infections, necrosis
pathogenesis of addisions disease
-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
Signs and sx of addison’s disease
- 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
what sx of addisons dz can occur at later stages
weight loss and dehydration
signs and sx of addisonian crisis
sudden onset:
-hyperpyrexia
-severe v/d
-severe abdominal and low back pain
-peripheral vascular collapse
-cyanosis
-confusion
Diagnostic labs in addison’s disease
-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
what is the most common cause of cushings syndrome
prolonged or high doses of exogenous corticosteroids
which cushing’s etiology is more common in women
endogenous causes 5X more common in women
(pituitary adenoma secreting ACTH)
cushings syndrome vs disease
syndrome: group of signs and symptoms
disease: pituitary adenoma
signs and sx of cushings
-impaired collagen production: spontaneous bruising, poor wound healing, purple striae over abdomen
- proximal muscle weakness
-bone loss
-hyperglycemia
-hypertension
-increased central fat deposit
dx labs for cushings
-electrolytes: ACTH issue? normal electrolyses, adrenal adenoma? abnormal electrolytes
- elevated serum and 24 hour urinary cortisol levels
ddx pituitary adenoma and SCC lung
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
Secondary adrenal insufficiency etiology
-Sheehans syndrome
-tumors, trauma
-discontinuation of exogenous steroids
Signs and sx of secondary adrenal insufficiency
- similar to addisons dx however there is no hyperpigmentation (low ACTH)
DX of secondary adrenal insufficiency
-electrolytes and aldosterone will be normal (not under control of ACTH)
-ACTH stimulation test results in increase cortisol levels
another name for primary hyperaldosteronism
conn syndrome
sx of conn syndrome
- muscle weakness
- palpitation, HTN
-H/A
-fatigue
-metabolic alkolosis
incidence of conn syndrome
2x more common in women
dx labs for conn syndrome
- hypokalemia
-hypernatremia
-aldosterone to renin ratio greater than 20:1
-normal ACTH and glucose
-abdominal CT scan for adenoma : distinguishes hyperplasia from primary hyperaldosterone
Etiology of conn syndrome
50% due to unilateral adenomas
40% due to bilateral hyperplasia
etiology of secondary hyperaldosteronism
stimulation by renin-angiotensin system (not adrenal gland)
-CHF
-liver cirrhosis
-nephrotic syndrome
sx of secondary hyperaldosteronism
symptoms similar to primary but more HTN and edema
pheochromocytoma incidence
adrenal medulla disorder
-rare
-young adults 20-40 yrs old
-95% are bening tumors
what is pheochromocytoma assocaited with
men II
sx of pheochromocytoma
- tremors, nervousness, H/A, sweating
-HTN, palpitations, tachycardia
may be episodic
dx of pheochromocytoma
- 24 hour urine for catecholamines and metabolites
-CT or MRI of the adrenal medulla
inheritance pattern in congenital adrenal hyperplasia
autosommal recessive
pathogenesis of congenital adrenal hyperplasia
21-hydroxylase deficiency in over 90% of cases
unable to make cortisol and aldosterone —- precursors shift to androgen synth
severe sx of congenital adrenal hyperplasia
-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)
mild sx of congenital adrenal hyperplasia
-hirsutism
-oligomenorrhea
-infertility
-acne
-orthostatic hypotension
-frequent illness
-poor response to stress
labs congenital adrenal hyperplasia
-hyponatremia
-hyperkalemia
-metabolic acidosis
-low aldosterone
low cortisol
hypoglycemia
