adrenal gland Flashcards
In response to low serum cortisol or stress…
the hypothalamus secretes corticotropin releasing factor (CRF)
In response to CRF…
the pituitary releases adrenocorticotropic hormone (ACTH)
In response to ACTH …
the adrenal glands secrete cortisol
In response to elevated cortisol levels…
the hypothalamus decreases production of CRF
Cortisol is produced by the ___ in a reaction to ___. Its main functions are to suppress ___ and increase available ___ by increasing ___ levels and promoting the breakdown of __ and ___. It also regulates ___
Cortisol is produced by the adrenal glands in a reaction to stress. Its main functions are to suppress the immune response and increase available energy by increasing blood sugar levels and promoting the breakdown of fat and protein. It also regulates electrolytes.
Cushing’s syndrome = ____ cortisol production
Addison’s disease = ___ cortisol production
Cushing’s syndrome = excessive cortisol production
Addison’s disease = low cortisol production
Cushing’s disease
Pituitary …
gender
Cushing’s disease
- Pituitary adenoma with hypersecretion of ACTH stimulating cortisol production in the adrenals.
- Women have a three times greater chance of having this than men.
Cushing’s syndrome
3 causes
- Adrenal tumor producing an increase in cortisol
- Ectopic production of ACTH – most commonly a small cell lung cancer
- Long term use of corticosteroids usually in treatment of another disease
cushing’s disease vs syndrome
syndrome is caused by an outside source (outside)
disease is caused by an inside source (pituitary)
most specific signs of cushings
proximal mm weakness, pigmented striae more than 1 cm wide(thigh, breast, abdomen), buffalo hump, truncal obesity, hirsutism
Sexual issues
hirsutism
Oligomenorrhea or amenorrhea
erectile dysfunction
cushings
Skin poor wound healing acne superficial skin infections bruising
cushings
Thirst and polyuria
Problems with calcium including kidney stones, osteoporosis, avascular necrosis
Mental – there is a spectrum from decreased concentration up through frank psychosis
cushings
cushings skin symptoms
poor wound healing
acne
superficial skin infections
bruising
cushings
-glucose, K++, cortisol
Glucose elevated
Hypokalemia
Cortisol is elevated
Glucose elevated
Hypokalemia
Cortisol is elevated
cushings
ACTH (cushings)
elevated
low
ACTH
elevated – pituitary or ectopic adenoma
low – adrenal tumor
cushings
MRI
CT
MRI for pituitary tumor
CT for adrenalcortical or other tumors
For Cushing’s disease (pituitary adenoma) tx
transsphenoidal resection
cushings: tumors causing the problem tx
Surgical removal of tumors causing the problem is the best option in all cases were that is possible, otherwise chemotherapy or radiation therapy is a possibility
If tumor cannot be destroyed or removed..
If tumor cannot be destroyed or removed – metyrapone and ketoconazole may suppress hypercortisolism. Parenteral octreotide may suppress ACTH
Parenteral octreotide…
Parenteral octreotide may suppress ACTH
what may suppress ACTH
Parenteral octreotide
what may suppress hypercortisolism.
metyrapone and ketoconazole may suppress hypercortisolism.
metyrapone and ketoconazole
may suppress hypercortisolism.
Often patients treated for Cushing’s syndrome will go into ___ withdrawal, …
cortisol withdrawal, Addison’s disease, and require hydrocortisone or prednisone.
adrenal cortex releases what 3 things
steroid hormones, aldosterone, cortisol
aldosterone 3 functions
- regulates BP
- retains Na
- secretes K+
cortisol functions (3)
- increase blood glucose
- breaks down fats/proteins/carbs
- regulates electrolytes
prognosis of cushings after succesful excision of a benign adrenal adenoma
95% chance of a 5 year survival
% of recurrence over 10 years with cushings
15-20%
what % of addison’s is secondary to autoimmune issues
- other 4 causes
80% Other causes include TB, genetic disorders, removal of adrenals, trauma(hemorrhaging)
addison’s secondary causes are …
pituitary based
calicification of adrenal glands
TB
precipated by infection, trauma, surgery, stress, lymphoma, metastatic cancer, amyloidosis, scleroderma, hemochromatosis, cessation of corticosteroid medications
adrenal crisis
There is a laundry list of vague findings including: GI symptoms(MANY), weakness, fatigue, weight loss, anorexia, muscle and joint pain, AMENORRHEA, nausea and vomiting, DELAYED deep tendon reflexes, emotional changes.
addison’s
Sparse axillary and pubic hair
Hyperpigmentation of skin especially of creases or pressure areas (waistband/bra line)
Hypotension typically systolic under 110 mmhg
Small heart
Salt craving
addison’s
addison’s symptoms
Sparse axillary and pubic hair
Hyperpigmentation of skin especially of creases or pressure areas (waistband/bra line)
Hypotension typically systolic under 110 mmhg
Small heart
Salt craving
addison’s
- menstuation
- hair
- reflexes
- BP
- amenorrhea
- sparse axillary and pubic hair
- delayed DTR
- low BP
hyperpigmentation in addison’s
only in primary disease when ACTH is elevated
hypotension, acute abd or low back pain, vomiting, diarrhea, dehydration, altered mental status
addisonian crisis; can be fatal if untreated
addison's - sodium, blood sugar, BUN - potassium, calcium \_\_\_ antibodies may be present ACTH is \_\_\_ in primary adrenal disease Plasma Cortisol is \_\_\_
Low – sodium and blood sugar, BUN
Elevated – potassium(only in primary disease), calcium
Antiadrenal and antithyroid antibodies(50%) may be present
ACTH is elevated in primary adrenal disease
Plasma Cortisol is low
Cosyntropin stimulation test or ACTH stimulation test
cosyntropin test is diagnostic; ACTH is injected and the plasma cortisol is then monitored for a reaction.
- a serum cortisol rise of more than 20 after adminstration of cosyntropin is nml; anything less is suspicious
imaging of addison’s
Chest x-ray for TB
Abdominal CT – small adrenal glands in an autoimmune disease
neutropenia, mild anemia, relative lymphocytosis, eosinophilia
addison’s
diagnostic (addison’s)
- early plasma cortisol and ACTH
low cortisol(under 3) and elevated ACTH(over 200)
DHEA level of 1,000
-produced where
- anything higher excludes Addison’s
- adrenal gland
addison’s tx
- Replacement with oral hydrocortisone (drug of choice) or prednisone.
Fludrocortisone
Has sodium retaining properties and be adjusted for clinical symptoms like edema of hypotension.
addison’s length of steroids
These are given for life and should be monitored by clinical symptoms as well as blood tests to assure proper dosing throughout the patient’s lifespan
addison’s tx for improved well being, increased muscle mass, reversal of femoral neck bone loss
DHEA; monitor for androgenic effects
addisonian crisis tx
IV saline, glucose, glucocorticoids and tx of underlying disease
high fever
low blood pressure
confusion or coma
hypoglycemia
adrenal crisis
give IV saline, glucose, glucocorticoids
primary and secondary addison’s differences
primary: assoc with increased skin pigmentation, decreased glucocorticoids and decreased mineralcorticoids
secondary: ONLY assoc with decreased glucocorticoids and DOES NOT have skin pigmentation or hyperkalemia
