Adrenal gland

Question 1

Differentiate between Cushing’s disease and Cushing’s syndrome.

Answer 1

Cushing’s disease:

-pituitary tumor (secondary hypercortisolism)

Cushing’s syndrome:

-pathology resulting in or resembling hypercortisolism)

Question 2

What are the expected changes in labs for Cushing’s syndrome caused by an adrenal tumor? (CRH, ACTH, and cortisol)

Would you see hyperpigmentation?

Answer 2

decreased CRH and ACTH

elevated cortisol

No hyperpigmentation (decreased ACTH)

Question 3

What are the expected changes in labs for Cushing’s syndrome caused by a pituitary tumor? (CRH, ACTH, and cortisol)

Would you see hyperpigmentation?

Answer 3

Cushing’s disease

decreased CRH

elevated ACTH and cortisol

Hyperpigmentation present (elevated ACTH)

Question 4

What are the expected changes in labs for Cushing’s syndrome caused by an ectopic ACTH-secreting tumor? (CRH, ACTH, and cortisol)

Answer 4

decreased CRH

elevated ACTH and cortisol

Question 5

What are the expected changes in labs for Cushing’s syndrome caused by exogenous glucocorticoids? (CRH, ACTH, and cortisol)

Would you see hyperpigmentation?

Answer 5

all decreased

No hyperpigmentation (decreased ACTH)

Question 6

How would you differentiate between Cushing’s disease and an ectopic ACTH-secreting tumor?

Answer 6

An ectopic ACTH-secreting tumor would not decrease ACTH secretion in response to high does dexamethasone.

A pituitary tumor in Cushing’s disease would show decreased ACTH secretion.

Question 7

What are the expected changes in labs for primary adrenal insufficiency? (CRH, ACTH, cortisol, and aldosterone)

Would you see hyperpigmentation?

Answer 7

decreased cortisol and aldosterone

elevated CRH and ACTH

hyperpigmentation present (elevate ACTH)

Question 8

What are the expected changes in labs for secondary adrenal insufficiency? (CRH, ACTH, cortisol, and aldosterone)

Would you see hyperpigmentation?

Answer 8

decreased ACTH and cortisol

increased CRH

normal aldosterone (RAA system)

no hyperpigmentation (decreased ACTH)

Question 9

How would you differentiate primary and secondary adrenal insufficiency?

Answer 9

Primary insufficiency would result in no mineralcorticoid production leading to hypovolemia

Secondary insufficiency would still be able to produce aldosterone via activation by the RAA system so there would be no hypovolemia

Question 10

What are the expected changes in labs for primary hyperaldosteronism? (renin and aldosterone)

Answer 10

Conn syndrome: excessive aldosterone secretion of adrenal cortex

decreased renin

elevated aldoserone

Question 11

What are the expected changes in labs for secondary hyperaldosteronism? (renin and aldosterone)

Answer 11

Excessive renin secretion from juxtaglomerular cells of kidney

elevated renin and aldosterone

Question 12

What labs and clinical findings would you expect from a 17α deficiency in the adrenal gland? (mineralcorticoids, cortisol, androgens, BP, [K⁺], and abnormal sexual characterisitics)

Answer 12

decreased cortisol and androgens

elevated aldosterone

high blood pressure (elevated aldosterone)

low potassium ( elevated aldosterone)

lack of secondary sex characteristics (decreased androgens)

Question 13

What labs and clinical findings would you expect from a 21β deficiency in the adrenal gland? (mineralcorticoids, cortisol, androgens, BP, [K+], and abnormal sexual characterisitics)

Answer 13

decreased mineralcorticoids, cortisol

elevated androgens

decreased BP (decreased mineralcorticoids)

increased [K⁺] (decreased mineral corticoids)

percocious puberty, virilization

Question 14

What labs and clinical findings would you expect from a 11β deficiency in the adrenal gland? (mineralcorticoids, cortisol, androgens, BP, [K+], and abnormal sexual characterisitics)

Answer 14

decreased aldosterone and cortisol

elevated DOC (weak minearalcorticoid) and androgens

high BP (elevated DOC)

low [K⁺] (elevated DOC)

virilzation