Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endocrine > Adrenal Disorders - Part 1 - Exam 3 > Flashcards

Adrenal Disorders - Part 1 - Exam 3 Flashcards

1
Q

What are the 2 types of tissues in the adrenal glands? They are both enclosed by _____

A

Cortex and Medulla

enclosed by a capsule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The ____ of the adrenal glands has 3 zones. Name them

A

Cortex

Zona Glomerulosa
Zona Fasciculata
Zona Reticularis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

____ is secreted from the Zona Glomerulosa (outer). What is the function?

A

mineralocorticoids primarily aldosterone

sodium retention
water retention
potassium excretion
increases blood pressure and blood volume

aka: kidneys retain Na, gets ride of K, when aldosterone is present, pee out K and keep Na and water follows so blood volume and pressure will increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the function of aldosterone? **What is the effect on Renin when aldosterone is in excess and deficient?

A

-Na retention and water follows
-K+ excretion

**Aldosterone excess
Renin ↓
Aldosterone deficiency
Renin ↑ **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

____ is secreted from the Zona Fasciculata (middle). What is the function?

A

glucocorticoids -> think cortisol

-gluconeogenesis in liver: utilizes (decreases) protein stores

-immune system suppression: ↓ eosinophil, lymphocytes and lymph tissue

-decreases inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is gluconeogenesis?

A

Gluconeogenesis refers to synthesis of new glucose from noncarbohydrate precursors, and provides glucose when dietary intake is insufficient or absent.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How much cortisol is released on a normal day? What happens when the body is stressed?

A

10-20 mg daily (basal level - w/o stress)

increased cortisol release during stress via ACTH stimulation (from the pituitary)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the HPA axis and its function.

A

hypothalamus releases corticotropin-releasing hormone (CRH) -> CRH goes to Anterior Pituitary Gland and adrenocorticotropic hormone (ACTH) is released -> ACTH goes to adrenal cortex and cortisol is released -> cortisol exerts a negative feedback in the hypothalamus and shuts off the release of CRH and ACTH

controls glucocorticoid release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the circadian rhythm of cortisol

A

highest in the morning around 8am and lowest around 8pm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

____ is secreted from the Zona Reticularis (inner). What is the function?

A

secretes gonadocorticoids

primarily dehydroepiandrosterone (DHEA)
converts to sex steroids in gonads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

The adrenal medulla is composed of ___ cells. What do they secrete?

A

chromaffin cells

secrete epinephrine and norepinephrine, which control the fight-or-flight response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

_____ can result in a chronic increase in a patient’s ACTH and CRH levels.

A

Destruction of the adrenal glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

______ stimulates adrenal cells to begin steroid synthesis.
Adrenal cells require _____ to synthesize steroid hormones.

A

ACTH

cholesterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

All steroidogenic pathways require _____ import into the mitochondrion, a process initiated by the action of the ______, which shuttles _____ from the outer to the inner mitochondrial membrane.

A

cholesterol

steroidogenic acute regulatory (StAR) protein

cholesterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

______ are very important in the process that forms aldosterone, cortisone, androgens and DHEAS. What happens if they mess up?

A

Enzymes

major effects on adrenal gland disfunction, could result in excessive amounts of sex hormones

??Consider memorizing this picture if times allows??

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is primary adrenal insufficiency?

A

adrenal gland dysfunction
↓ cortisol/aldosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is secondary adrenal insufficiency?

A

pituitary gland dysfunction
↓ ACTH
↓ cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is tertiary adrenal insufficiency?

A

hypothalamic dysfunction
↓ CRH
↓ ACTH
↓ cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Why is aldosterone not affected in secondary or tertiary adrenal insufficiency?

A

aldosterone is controlled by the RAA system and not the HPA axis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

____ is a destruction/dysfunction of the adrenal cortex resulting in insufficient production of glucocorticoids and mineralocorticoids

A

Addison’s disease aka primary adrenal insuffiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the MC cause of Addison’s disease? What are the autoantigen’s involved? What age range?

A

autoimmune destruction of adrenal enzymes (80% of cases in US) slow decrease over several years

**CYP21A2 (21-hydroxylase) - MC autoantigen
CYP11A1 (side-chain cleavage enzyme)
CYP17 (17-alpha-hydroxylase)

10-40 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What will a reduction/malfunction of CYP17A1 lead to?

A

excessive aldosterone and reduction in all hormones created by the adrenal gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

_______ genetic disorder resulting in accumulation of very long-chain fatty acids in the adrenal cortex. What does it inhibit?

A

Adrenoleukodystrophy

inhibiting the effects of ACTH on the adrenocortical cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

______ genetic mutation or absence of adrenal cortex

A

Congenital adrenal insufficiency/hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the MC cause of infectious Addison’s disease?

A

TB but rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Chronic Addison’s dz can be caused by ORAL ketoconazole. Why?

A

inhibits the production of cortisol by blocking the CYP450 enzyme

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

phenytoin, barbiturates, rifampin all can ???? causing ????

A

accelerate the metabolism of cortisol

causing Addison’s disease

aka the drugs break cortisol down faster before it can do its job

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

_____ is an adrenocorticolytic drug that diminishes cortisol synthesis by blocking steroid biosynthesis - used to treat adrenocortical carcinoma

A

mitotane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

**_______ suppress the CRH or ACTH production.

A

glucocorticoids

stopping steroid’s abruptly can cause addison’s dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are 2 causes of acute addison’s dz?

A

Adrenal hemorrhage

Adrenal “addisonian” Crisis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What can cause an adrenal hemorrhage?

A

results from sepsis, heparin-induced thrombocytopenia, anticoagulation, antiphospholipid antibody syndrome, trauma, surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

**What is an adrenal crisis usually caused by?

A

insufficient cortisol caused by physical or emotional stress in an Addison’s pt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Bronze pigmentation of skin (extensor surfaces, palmar creases, nail beds, mucosal membranes)
changes in distribution of body hair
GI disturbances: abdominal pain, N/V/D
weakness, fatigue, decrease in stamina
hypoglycemia
postural hypotension
weight loss, dehydration
anorexia
slow onset and nonspecific s/s
vitiligo in 10% of pts
generalized pain
anxiety, irritability, depression
gait disturbances, cognitive dysfunction
amenorrhea (25% of female pts)

What am I?
**What are the first symptoms?

A

Chronic addison’s dz presentation

anorexia, weight loss, fatigue, ↓ stamina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

profound fatigue
dehydration
vascular collapse decrease BP
renal shut down
decrease serum Na
increase serum K

What am I?

A

acute addison’s dz

35
Q

What is the function of mineralcorticoids?

A

increase Na retention
increase water in the blood vessel
increase blood volume and pressure
K is eliminated into the urine

35
Q

What is the function of glucocorticoids?

A

gluconeogensis in the liver
decreases the immune response
decreases protein stores aka muscle break down
decreased inflammation

36
Q

Why do patients with Addison’s disease present with hyperpigmentation?

A

ACTH attaches to melanotic receptors

37
Q

What is vitiligo? When will you see it? What is it a result from?

A

patchy hypopigmentation

result of autoimmune destruction of dermal melanocytes

occurs in 10% of chronic addison’s dz patients

38
Q

sudden onset
severe fever - 105℉ or higher
severe abdominal pain, nausea, vomiting
similar to an “acute abdomen¹”
confusion
hypotensive shock
weakness, dizziness, syncope, hypotension, tachycardia

A

Addison’s dz Adrenal crisis

39
Q

**What is the key difference between an adrenal hemorrhage and an adrenal crisis?

A

adrenal hemorrhage will present like adrenal crisis without the fever

40
Q

What will each lab value show of pt with addison’s dz? CBC and CMP

A

CBC:eosinophilia, lymphocytosis

CMP: hyponatremia, hyperkalemia (unless the pt has been vomiting/diarrhea may mask hyperkalemia)
↑ BUN/Cr - results from dehydration
hypoglycemia if fasting or may occur spontaneously

41
Q

**What additional tests would you want to order if you suspect Addison’s dz? What results would you expect?

A

Plasma Cortisol at 8am! low cortisol (less than 3mcg) AND elevated ACTH

low cortisol AND high ACTH
______

Plasma ACTH should be high in Addison’s dz

greater than > 200 pg/mL (7-63 pg/mL - normal value 7-10 AM)

42
Q

How would you rule OUT addison’s disease in am emergency setting?

A

Random cortisol > 25 mcg/dL usually rules out Addison’s

43
Q

Describe the rapid ACTH stimulation test. When is it indicated? When is it used? What results would you expect with a pt with Addison’s dz?

A

when serum cortisol and serum ACTH are non-diagnostic

Pre-test: hold steroids 24 hours before test
Hospital setting
Step 1: Measure serum cortisol
Step 2: Administer Cosyntropin (synthetic ACTH) 0.25 mg given IM
Step 3: Measure serum cortisol 45 minutes post injection
————
Normal - rise in serum cortisol ≥ 20 mcg/dL
a rise could also indicated a

Addison’s Disease - rise in serum cortisol less < 20 mcg/dL

normal should rise more than 20mcg, Addison’s there is a minor to no increase

44
Q

When in the plasma renin test used? What would you expect to see? What is the drawback?

A

on a pt with Addison’s dz to determine if they need mineralcorticoid replacement

increased in Addison’s disease due to diminished aldosterone resulting in depleted intravascular volume

has MANY interfering factors!!

45
Q

What imaging would you order for a pt with Addison’s dz? Why?

A

CXR: if you suspect TB or pneu

CT of the abdomen to scan the adrenal gland

46
Q

What are some common finds on a CT of the abdomen on a Addison’s pt? What does it mean?

A

small without calcifications - autoimmune

enlarged - TB, fungal, adrenal hemorrhage, metastatic

calcifications - TB, fungal, adrenal hemorrhage, pheochromocytoma, melanoma

47
Q

What is the treatment for chronic addison’s dz? What is the dosing? What is the alt?

A

Hydrocortisone 15-30 mg daily: ⅔ dose in morning and ⅓ dose in late afternoon/early evening

Prednisone or methylprednisolone alternative glucocorticoids

AND

Fludrocortisone 0.05–0.3 mg daily or every other day

48
Q

What is the treatment for Addison’s dz if the pt is stressed?

A

increase dose of glucocorticoid by up to 50%

at higher stress doses of glucocorticoids (> 100 mg/d of hydrocortisone) Fludrocortisone is not needed

49
Q

How do you monitor fludrocortisone? When do you need to increase the dose?

A

monitor with PRA - if increased, fludrocortisone dose needs increased

orthostatic hypotension, hyponatremia, hyperkalemia

50
Q

What is the treatment for an acute addison’s dz?

A

1st: order serum cortisol and ACTH but DO NOT WAIT on results to start treatment

1st: IV hydrocortisone then switch to oral hydrocortisone once the pt can tolerate oral intake

2nd: broad spectrum abx and treat all electrolyte abnormalities

51
Q

What is the addison’s dz management and monitoring?

A

monitor for Cushing Syndrome

WBC w/ diff to monitor for electrolytes and renal function

DEXA scan: screen for osteoporosis

52
Q

What are some pt education points to know about Addison’s dz?

A

medical alert bracelet

all infections must be treated immediately: aka the abx threshold is much lower

educate the pts on how to do injectable hydrocortisone

53
Q

______ a condition that results from an excessive amount of systemic cortisol. What is the MC cause? Is it ACTH dependent or independent?

A

Cushing’s SYNDROME

aka too many prescribed steroids

Independent

54
Q

_____ manifestations of excessive corticosteroids due to hypersecretion of ACTH. What is the MC cause? What gender?
Is it ACTH dependent or independent?

A

Cushing DISEASE

benign anterior pituitary adenoma
females > male

dependent

55
Q

What are 4 causes of Cushing DISEASE?

A

pituitary hypersecretion of ACTH

Ectopic secretion of ACTH

Ectopic secretion of CRH

factitious Cushing’s syndrome: due to administration of exogenous ACTH – rare < 1 %

56
Q

Ectopic secretion of ACTH is caused by ??? Name some common locations

A

non-pituitary tumor - MC locations lungs, thymus, pancreas

57
Q

Ectopic secretion of CRH are caused by ???

A

non-hypothalamic tumors causing pituitary hypersecretion of ACTH - rare < 1 %

58
Q

What are the effects of cortisol?

A

gluconeogensis
decreased protein stores
suppresses the immune system
decreased inflammation

59
Q

How does ACTH affect aldosterone?

A

ACTH can stimulate the adrenal cells of the zona glomerulosa to release aldosterone outside of the RAAS

60
Q

Fatigue
reduced physical endurance
weight gain: central obesity with protuberant abdomen with thin extremities
mood face
supraclavicular fat pads
buffalo hump
skin atrophy with large purple striae
easy bruisability
proximal muscle weakness: especially shoulders and hips
immune system suppression: frequent infections
menstrual irregularities
hyperpigmentation
elevated BP
hirsutism, male pattern hair loss

What am I?

A

Cushing disease

61
Q

What would a CBC and CMP look like on a pt with Cushing’s syndrome?

A

CBC: leukocytosis with neutrophilia¹, lymphocytopenia, ↓ eosinophils

CMP: elevated glucose
+/- hypernatremia, hypokalemia

62
Q

When would you expect to find abnormal Na and K levels?

A

Cushing’s disease increase in ACTH stimulates aldosterone

Zona glomerulosa is secreting too much aldosterone

63
Q

What is the workup goals for Cushing disease?

A

Is it due to excessive steroid use?
Is there hypercortisolism? then determine the cause

64
Q

What are the 3 first line tests for Cushings? When can you dx Cushings?

A

Dexamethasone Suppression Test

24 Urine Free Cortisol (2 separate measurements)

Late night salivary cortisol (2 separate measurements)

**need TWO positive tests for diagnosis

65
Q

What are the guidelines when performing a Low-dose Dexamethasone Suppression Test? What can cause the test to be “off’?

A

give dexamethasone 1 mg PO at 11 PM then serum cortisol next morning at 8 AM

Results - < 5 mcg/dL likely excludes Cushing’s syndrome

3% false-negative rate: antiseizure drugs, rifampin and estrogens diminish suppressibility

20-30% false-positive rate: psychiatric disorders, emotional/physical stress

66
Q

What are the guidelines for 24 hour urine free cortisol test? What is considered a positive test?

A

day 1: first morning void in the toilet, collect all urine throughout the day

day 2: first morning void in the jug

test complete

3x upper limit of normal on both occasions (around 150mcg)

67
Q

What are the guidelines for the late night salivary cortisol test?

A

Place swab in mouth and leave for 90 seconds. Allow saliva to saturate. Do not chew swab

collected by patient between 11 pm and midnight. Normal: less than 100

lots of interfering factors!: steroid use, brushed teeth, oral intake, inadequate collection

must be performed on 2 separate occasions!! and both must be elevated to be positive

68
Q

What are some conditions in which a late night salivary test might be falsely elevated.

A

erratic sleep schedules or shift work
pregnancy
exogenous steroid/estrogen use, anticonvulsants
mental illness, chronic alcohol use
acute stress (hospitalization/surgery)

69
Q

what are the guidelines for Cushing dz test interpretation.

A

2 first line test with negative results
if low index of suspicion - no further workup - monitor pt
if high index of suspicion - refer to endocrinologist

1 out of 2 are positive:
repeat test at random intervals
consider: cyclic Cushing Disease as dx
refer to endo

2/2 are positive
refer to endo

70
Q

What is the MC cause of cyclic Cushing Disease?

A

ACTH-secreting pituitary adenoma

71
Q

_____ is a good test to order when determining the cause for hypercortisolism. Why? **How do you interpret the results?

A

Serum ACTH

will differentiate ACTH-dependent vs. ACTH-independent etiology

**interpretation
< 20 pg/dL order adrenal CT; > 20 pg/dL order pituitary MRI

72
Q

**What are the three red flags for malignant adrenal gland CT?

A

greater than > 4 cm

growth of nodule (requires previous CT for comparison)

density of lesion is > 10 Hounsfield units (HU)

73
Q

What is the best way to view the pituitary gland? What is the parameter for treatment if you find a lesion?

A

MRI with contrast

lesion greater than 5mm begin treatment

no lesion or lesion less than 5mm do an inferior petrosal sinus sampling

74
Q

the inferior petrosal sinus sampling comes back elevated, what does this mean? normal?

A

elevated ACTH levels - pituitary Cushing’s disease

normal ACTH level - look for ectopic source of ACTH, order CT scan of chest/abdomen. If negative, perform whole body PET scan

75
Q

When stopping glucocorticoid/ACTH therapy, what is the protocol?

A

prolonged therapy can suppress the HPA axis; rapid withdrawal can result in acute adrenal insufficiency

HPA axis is usually fully recovered within 6-12 months

76
Q

What is the management for Cushing dz caused by a adenoma/ACTH-secreting tumor?

A

surgery: post surgical adrenal insufficiency will require lifelong glucocorticoid replacement

radiation

77
Q

While waiting for sx or sx not an option, how do you treat Cushings Dz?

A

**11β-hydroxylase inhibitors - blocking cortisol steroidogenesis

78
Q

What is the medical management for a pituitary ACTH tumor?

A

pasireotide (Signifor) - somatostatin analog - inhibits ACTH secretion

79
Q

What is the medical management for an adrenocortical carcinoma?

A

mitotane - blocks cortisol secretion

80
Q

What is the medical management of mineralcorticoid HTN?

A

1st: K+ sparing diuretic: spironolactone, eplerenone

2nd: ACEI

81
Q

_____ is given to women for hyperandrogenism. Its MOA inhibits androgen uptake and/or inhibits binding of androgen in target tissues

A

flutamide

82
Q

What are some other conditions that commonly arise along side of Cushings dz?

A

HTN, DM, increased risk of infection, complications from osteoporosis, nephrolithiasis, psychosis

83
Q
A

Endocrine (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions