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endocrine > adrenal gland > Flashcards

adrenal gland Flashcards

1
Q

In response to low serum cortisol or stress…

A

the hypothalamus secretes corticotropin releasing factor (CRF)

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2
Q

In response to CRF…

A

the pituitary releases adrenocorticotropic hormone (ACTH)

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3
Q

In response to ACTH …

A

the adrenal glands secrete cortisol

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4
Q

In response to elevated cortisol levels…

A

the hypothalamus decreases production of CRF

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5
Q

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 ___

A

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.

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6
Q

Cushing’s syndrome = ____ cortisol production

Addison’s disease = ___ cortisol production

A

Cushing’s syndrome = excessive cortisol production

Addison’s disease = low cortisol production

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7
Q

Cushing’s disease
Pituitary …
gender

A

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.
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8
Q

Cushing’s syndrome

3 causes

A
  • 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
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9
Q

cushing’s disease vs syndrome

A

syndrome is caused by an outside source (outside)

disease is caused by an inside source (pituitary)

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10
Q

most specific signs of cushings

A

proximal mm weakness, pigmented striae more than 1 cm wide(thigh, breast, abdomen), buffalo hump, truncal obesity, hirsutism

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11
Q

Sexual issues
hirsutism
Oligomenorrhea or amenorrhea
erectile dysfunction

A

cushings

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12
Q 
Skin
poor wound healing
acne
superficial skin infections
bruising
A

cushings

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13
Q

Thirst and polyuria
Problems with calcium including kidney stones, osteoporosis, avascular necrosis
Mental – there is a spectrum from decreased concentration up through frank psychosis

A

cushings

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14
Q

cushings skin symptoms

A

poor wound healing
acne
superficial skin infections
bruising

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15
Q

cushings

-glucose, K++, cortisol

A

Glucose elevated
Hypokalemia
Cortisol is elevated

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16
Q

Glucose elevated
Hypokalemia
Cortisol is elevated

A

cushings

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17
Q

ACTH (cushings)
elevated
low

A

ACTH
elevated – pituitary or ectopic adenoma
low – adrenal tumor

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18
Q

cushings
MRI
CT

A

MRI for pituitary tumor

CT for adrenalcortical or other tumors

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19
Q

For Cushing’s disease (pituitary adenoma) tx

A

transsphenoidal resection

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20
Q

cushings: tumors causing the problem tx

A

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

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21
Q

If tumor cannot be destroyed or removed..

A

If tumor cannot be destroyed or removed – metyrapone and ketoconazole may suppress hypercortisolism. Parenteral octreotide may suppress ACTH

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22
Q

Parenteral octreotide…

A

Parenteral octreotide may suppress ACTH

23
Q

what may suppress ACTH

A

Parenteral octreotide

24
Q

what may suppress hypercortisolism.

A

metyrapone and ketoconazole may suppress hypercortisolism.

25
Q

metyrapone and ketoconazole

A

may suppress hypercortisolism.

26
Q

Often patients treated for Cushing’s syndrome will go into ___ withdrawal, …

A

cortisol withdrawal, Addison’s disease, and require hydrocortisone or prednisone.

27
Q

adrenal cortex releases what 3 things

A

steroid hormones, aldosterone, cortisol

28
Q

aldosterone 3 functions

A
  • regulates BP
  • retains Na
  • secretes K+
29
Q

cortisol functions (3)

A
  • increase blood glucose
  • breaks down fats/proteins/carbs
  • regulates electrolytes
30
Q

prognosis of cushings after succesful excision of a benign adrenal adenoma

A

95% chance of a 5 year survival

31
Q

% of recurrence over 10 years with cushings

A

15-20%

32
Q

what % of addison’s is secondary to autoimmune issues

- other 4 causes

A

80% Other causes include TB, genetic disorders, removal of adrenals, trauma(hemorrhaging)

33
Q

addison’s secondary causes are …

A

pituitary based

34
Q

calicification of adrenal glands

A

TB

35
Q

precipated by infection, trauma, surgery, stress, lymphoma, metastatic cancer, amyloidosis, scleroderma, hemochromatosis, cessation of corticosteroid medications

A

adrenal crisis

36
Q

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.

A

addison’s

37
Q

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

A

addison’s

38
Q

addison’s symptoms

A

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

39
Q

addison’s

  • menstuation
  • hair
  • reflexes
  • BP
A
  • amenorrhea
  • sparse axillary and pubic hair
  • delayed DTR
  • low BP
40
Q

hyperpigmentation in addison’s

A

only in primary disease when ACTH is elevated

41
Q

hypotension, acute abd or low back pain, vomiting, diarrhea, dehydration, altered mental status

A

addisonian crisis; can be fatal if untreated

42
Q 
addison's
- sodium, blood sugar, BUN
- potassium, calcium
\_\_\_ antibodies may be present
ACTH is \_\_\_ in primary adrenal disease
Plasma Cortisol is \_\_\_
A

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

43
Q

Cosyntropin stimulation test or ACTH stimulation test

A

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

44
Q

imaging of addison’s

A

Chest x-ray for TB

Abdominal CT – small adrenal glands in an autoimmune disease

45
Q

neutropenia, mild anemia, relative lymphocytosis, eosinophilia

A

addison’s

46
Q

diagnostic (addison’s)

- early plasma cortisol and ACTH

A

low cortisol(under 3) and elevated ACTH(over 200)

47
Q

DHEA level of 1,000

-produced where

A
  • anything higher excludes Addison’s

- adrenal gland

48
Q

addison’s tx

A
  • Replacement with oral hydrocortisone (drug of choice) or prednisone.
49
Q

Fludrocortisone

A

Has sodium retaining properties and be adjusted for clinical symptoms like edema of hypotension.

50
Q

addison’s length of steroids

A

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

51
Q

addison’s tx for improved well being, increased muscle mass, reversal of femoral neck bone loss

A

DHEA; monitor for androgenic effects

52
Q

addisonian crisis tx

A

IV saline, glucose, glucocorticoids and tx of underlying disease

53
Q

high fever
low blood pressure
confusion or coma
hypoglycemia

A

adrenal crisis

give IV saline, glucose, glucocorticoids

54
Q

primary and secondary addison’s differences

A

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

endocrine (9 decks)

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