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Foundations-Endocrine > Adrenal Gland > Flashcards

Adrenal Gland Flashcards

1
Q

What is the cause of a primary disorder?

A

Target organ

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2
Q

What is the cause of a secondary disorder?

A

Pituitary

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3
Q

What is the cause of a tertiary disorder?

A

Hypothalamus

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4
Q

What does the outer zone of the adrenal cortex produce?

A

Mineralocorticoids: Aldosterone

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5
Q

What does the middle zone of the adrenal cortex produce?

A

Glucocorticoids: Cortisol

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6
Q

What does the inner zone of the adrenal cortex produce?

A

Adrenal Androgens: (Dehydroepiandrosterine [DHEA])

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7
Q

What the adrenal medulla produce?

A

Catecholamines: Epi & NE

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8
Q

Effects of long-term high-dose glucocorticoid therapy?

A

Adrenal Atrophy

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9
Q

Primary overproduction of cortisol by the adrenal glands inhibits the secretion of?

A

ACTH

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10
Q

Effects of cortisol?

A
  1. Protects against hypoglycemia: Gluconeogenesis, proteolysis, lipolysis
  2. Decrease insulin sensitivity
  3. Anti-inflammatory
  4. Immunosupression
  5. Inhibits bone formation
  6. Promotes increase in GFR
  7. Maintain vascular responsiveness to NE/Epi
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11
Q

DHEA effects in females

A
  1. Early development of pubic and axillary hair development

2. Masculinization in females

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12
Q

When should you check cortisol levels?

A

Between 8 a.m. and 9 a.m

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13
Q

What cortisol lab value would indicate adrenal insufficiency?

A

<3 mg/dL

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14
Q

What cortisol lab value would NOT indicate adrenal insufficiency?

A

> 10 mg/dL

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15
Q

What test is ideal for suspected hypercortisolism?

A

24-hour urine collection

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16
Q

What can a plasma ACTH test with cortisol help you differentiate?

A

Differentiate primary (adrenal) from secondary (pituitary) and tertiary (hypothalamic) source of cortisol imbalance

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17
Q

With an ACTH Stimulation Test, what does double the cortisol levels indicate?

A

Adrenal gland is functioning

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18
Q

With an ACTH Stimulation Test, what does subnormal cortisol levels indicate?

A

Adrenal Insufficiency

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19
Q

With a Dexamethasone Suppression Test, what does NO change in cortisol levels indicate?

A

Excess cortisol production

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20
Q

With a Dexamethasone Suppression Test, what does suppressed cortisol levels indicate?

A

Adrenal gland is functioning

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21
Q

What is the MC Exogenous cause for Cushing’s syndrome?

A

Chronic excess glucocorticoid (i.e. corticosteroid)

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22
Q

What is the MC Endogenous cause for Cushing’s Disease?

A

Pituitary Adenoma

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23
Q

Other causes for Cushing’s Disease?

A
  1. Adrenal hyperplasia
  2. Adrenocortical tumor
  3. Neuroendocrine tumor (i.e. MEN I)
  4. Ectopic production: Small cell lung CA, Ovarian CA
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24
Q

Who is Cushing Disease MC in?

A

Females

25
Q

What is the imaging of choice when evaluation for a pituitary tumor?

A

MRI of the pituitary gland

26
Q

Cushing Syndrome Clinical Manifestations

A
  1. HTN
  2. Central Obesity: Moon facies, supraclavicular/cervical fat pad
  3. Insulin Resistance
  4. Purple Striae
  5. Androgen excess: hirsutism, acne, menstrual irregularities
27
Q

Diagnostic criteria/findings in Cushing’s syndrome

A
  1. 24-hour urinary free cortisol levels: Elevated
  2. Midnight salivary cortisol level: Elevated on 2 separate nights
  3. Dexamethasone suppression test: No change in cortisol levels
28
Q

Adrenal Hyperplasia or tumor lab findings

A

High Cortisol levels

Low ACTH levels

29
Q

ACTH producing tumor – pituitary or ectopic lab findings

A

High Cortisol levels

High ACTH levels

30
Q

IF you suspect an ectopic ACTH secreting tumor, what would you order?

A
  1. CXR: r/o lung mass (small cell lung CA)

2. Pelvic US: r/o ovarian mass

31
Q

Exogenous corticosteroid tx in Cushing’s syndrome

A

Taper to lowest therapeutic dose

32
Q

Pituitary adenoma tx in Cushing’s syndrome

A

Transsphenoidal resection

33
Q

Adrenal tumor tx in Cushing’s syndrome

A

Adrenalectomy

34
Q

Adrenal hyperplasia tx in Cushing’s syndrome

A

Medical management

35
Q

Ectopic ACTH Syndrome tx in Cushing’s syndrome

A

Targeted at source of ectopic production

36
Q

Pharmacological treatment/management of Cushing’s syndrome

A
  1. Adrenolytic Agents:
    Mitotane
  2. Adrenal Enzyme Inhibitors: Ketoconazole, Metyrapone
37
Q

In the US, what is the MC cause of primary adrenal insufficiency?

A

Autoimmune cortical destruction: Addison’s disease= mineralocorticoid & glucocorticoid deficiencies

38
Q

Worldwide, what is the MC cause of primary adrenal insufficiency?

A

TB

39
Q

What is the MC cause of secondary adrenal insufficiency?

A

Exogenous steroid

40
Q

What can the abrupt withdrawal of steroids cause?

A

Addison’s crisis

41
Q

Adrenal Insufficiency Clinical Presentation

A
  1. Nonspecific sx’s: Weakness, fatigue, anorexia, wt. loss
  2. Orthostatic Hypotension
  3. Hypoglycemia
  4. Salt Cravings
  5. Hyperpigmentation*
  6. GI complaints
42
Q

Addison’s Crisis Clinical Presentation

A

Sudden onset/rapid escalation:

  1. Hypotension
  2. Acute pain: Abdomen/low back
  3. Vomiting
  4. Diarrhea
  5. Dehydration
  6. AMS
43
Q

Lab findings in Adrenal Insufficiency

A
  1. Hyperkalemia
  2. Hypercalcemia
  3. Hyponatremia
  4. Eosinophilia
  5. Andi-adrenal antibodies= 70% of pt’s d/t autoimmune destruction
  6. Low plasma cortisol
44
Q

Primary adrenal insufficiency treatment

A

Glucocorticoid (hydrocortisone) + Mineralocorticoid (fludrocortisone) replacement

45
Q

Secondary/Tertiary adrenal insufficiency treatment

A

Glucocorticoid: hydrocortisone

46
Q

What can be given to women with adrenal insufficiency?

A

DHEA

47
Q

Adrenal crisis treatment

A
  1. IV steroids
  2. Correct electrolyte abnormalities
  3. 50% dextrose
  4. Volume resuscitation
48
Q

Primary Hyperaldosteronism (Conn’s Syndrome) etiology

A
  1. Adrenocortical adenoma= 73%

2. Cortical hyperplasia=27%

49
Q

Primary Hyperaldosteronism Clinical Presentation

A
  1. HTN
  2. Hypokalemia
  3. Muscular weakness
  4. Paresthesias
  5. Headache
  6. Polyuria & polydipsia
50
Q

Lab findings in Primary Hyperaldosteronism

A
  1. Elevated plasma and urine aldosterone

2. Low plasma renin levels

51
Q

What imaging would you want to order in Primary Hyperaldosteronism? Why?

A

CT adrenals to evaluate for adrenal adenoma

52
Q

Primary Hyperaldosteronism Mangement/treatment

A
  1. Surgical: removal of adenoma

2. Meds: Spironolactone + Antihypertensive agents

53
Q

Define Pheochromocytoma

A

Rare tumor that arises from chromaffin cells:

  1. Secrete catecholamines
  2. Located in adrenal medulla= 80% to 90%
54
Q

Pheochromocytoma Clinical Presentation

A
  1. Paroxysmal Palpitations: Tachycardia
  2. HA
  3. Episodic sweating
  4. HTN: Paroxysmal OR Sustained
55
Q

When should you suspect Pheochromocytoma?

A
  1. Classic paroxysmal “attacks”
  2. Refractory HTN or onset <20 y/o
  3. Idiopathic dilated cardiomyopathy
  4. Abdominal mass
  5. Family history
  6. Incidentally discovered adrenal mass
56
Q

What is the first line screening test in the diagnose of a Pheochromocytoma?

A

Metanephrine (catecholamine metabolite) 24-hour urine screen

57
Q

What would you order to identify extra-adrenal tumors in Pheochromocytoma?

A

MIBG scintigraphy

58
Q

Pheochromocytoma treatment

A

Surgical resection

59
Q

Pheochromocytoma treatment prior to surgery

A
  1. Alpha blocker: phenoxybenzamine

2. Beta-Blocker: Propanalol

Foundations-Endocrine (4 decks)

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