Adrenal Gland

Question 1

11-Beta Hydroxylase

Synthesis Action and Deficiency Presentation/Lab Values

Answer 1

Makes corticosterone and cortisol

Presents with Hypertension, virulization and ambiguous genitalia

Low aldosterone, cortisol, potassium and renin
High androgens

Question 2

21-Alpha Hydroxylase

Synthesis Action and Deficiency Presentation/Lab Values

Answer 2

Oxidizes progesterone for aldosterone and cortisol

Presents with hypotension, salt wasting and pernicious puberty

Low aldosterone, cortisol, sodium
High androgens, potassium and renin

Question 3

17-Alpha Hydroxylase

Synthesis Action and Deficiency Presentation/Lab Values

Answer 3

Makes 17-OH Pregnenolone

Presents with HTN and lack of sexual development

Low cortisol, androgens and potassium
High aldosterone

Question 4

Cortisol Secretion Stimulation

Answer 4

Stimulated by ACTH from AP

Stimulated by stress and circadian rhythm (increased in AM)

Question 5

Cortisol Secretion Negative Feedback

Answer 5

Cortisol feeds back on hypothalamus and anterior pituitary
Decreases CRH and ACTH

Exogenous glucocorticoids feed back on same loop

Question 6

Aldosterone Stimuli

Answer 6

Increased angiotensin, potassium, ACTH and stress
or
Decreased sodium, blood pressure

Question 7

Cushing’s Syndrome (primary adrenal excess)

Pathophysiology, Presentation and Diagnosis

Answer 7

Zona fasciculata adenoma
Causes decreased CRH/ACTH and increased cortisol

Presents with trunk obesity, moon face, buffalo hump, easy bruising, immunodeficiency

Diagnosed with negative Dexamethasone test

Question 8

Cushing’s Disease (secondary adrenal excess)

Pathophysiology and Diagnosis

Answer 8

Anterior Pituitary adenoma
Causes increased ACTH/Cortisol and decreased CRH

Diagnosed with positive high dose Dexamethasone test
Decreased ACTH after dose

Question 9

Hyperpigmentation

Cause and Associated Diseases

Answer 9

Increased ACTH

Seen in Cushing’s Disease and Addison’s Disease

Question 10

Ectopic ACTH Tumor

Pathophysiology and Diagnosis

Answer 10

Form of Cushing’s Syndrome
Adrenal ACTH adenoma
Increased Cortisol and decreased CRH/plasma ACTH

Diagnosed with negative dexamethasone test

Question 11

Latrogenic Hypocortisolism

Pathophysiology

Answer 11

Form of Cushing’s Syndrome
Excessive exogenous glucocorticoids
Causes decreased CRH/ACTH/Endogenous Cortisol

Question 12

Addison’s Disease (primary adrenal insufficiency)

Pathophysiology, Presentation, Lab Values and Diagnosis

Answer 12

Autoimmune adrenal destruction of adrenal hemorrhage
Causes decreased mineral/glucocorticoids

Presents with hyperpigmentation and hypoglycemia

Increased CRH/ACTH/Potassium
Decreased Cortisol/Aldosterone/Sodium/Glucose

Diagnose with no effect on cortisol aftercosyntropin

Question 13

Secondary/Tertiary Adrenal Insufficiency

Pathophysiology, Lab Values, Diagnosis

Answer 13

Caused by decreased ACTH from Pituitary Gland

Decreased ACTH/Cortisol
Normal Salt Balance/Aldosterone (RAAS)

Diagnose with increased cortisol after cosyntropin

Question 14

Hyperaldosteronism Cause

Primary and Secondary

Answer 14

Primary: Zona glomerulosa adenoma causing increased aldosterone and decreased renin

Secondary: Excessive renin secretion or 17-Alpha Hydroxylase defect

Question 15

Hypoaldosteronism Cause

Answer 15

Adrenal gland destruction or aldosterone synthesis issue

11-Beta or 21-Alpha Hydroxylase defects

Question 16

Pheochromocytoma

Pathophysiology, Presentation, Lab Values

Answer 16

Adrenal medulla adenoma causing excessive catecholamine secretion

Presents with extreme HTN, sweating, increased HR, pale

Shows increased metanephrine/normetanephrine

Question 17

Catecholamine Synthesis Steps

Answer 17

ACTH increases DOPA which becomes Dopamine
Ach causes DA to become Norepinephrine
Cortisol causes NE to become Epinephrine using PNMT enzyme

Question 18

Catecholamine Degradation

Enzyme, Products, Excretion

Answer 18

Uses catecholamine-O-methyltransferase (COMT)

Epinephrine made into metanephrine
Norepinephrine made into normetanephrine

Excreted as Vanillylmandelic acid (VMA)