Adrenal Gland Disorders

Question 1

• Excessive Corticosteroids
• Exogenous corticosteroids or primary tumor
• Moon facies, muscle atrophy, thin skin, purple striae, supraclavicular fat pads
• Midnight salivary cortisol level, urinary cortisol, Dexmethasone suppression test
• Medications, resection

Answer 1

Cushing syndrome (Hypercortisolism)

Question 2

• Persistant/episodic HTN
• Adrenal medulla tumor
• Attacks of HA; diaphoresis, palpitations, anxiety
• CT/MRI
• Resection

Answer 2

Pheochromocytoma

Question 3

• Insufficient cortisol due to stress (trauma, surgery, infx, hyperthyroid, withdrawal from steroid tx)
• Weakness, abd pain, fever, confusion, low BP, hyper pigmentation (esp. creases)
• increased K, decreased Na
• Cosyntropin unable to raise cortisol
• Hydrocortisone & broad Abx

Answer 3

Acute Adrenal Insufficiency (Adrenal Crisis)

Question 4

• Excessive aldosterone production
• Tumor or adrenal hyperplasia
• Moderate to severe &/or drug resistant HTN
• Incrased plasma aldosterone, decreased renin
• Spironolactone; resection

Answer 4

Primary hyperaldosteronism

Question 5

• polycystic ovarin syndrome
• oligomenorrhea, acne, increased muscularity, deepening of voice, balding
• Testosterone level; adrenal CT, pelvic CT
• Meds; resection of T secreting tumor

Answer 5

Hirsuitism and virilization

Question 6

• Chronic Defficiency of cortisol
• Dysfunction/absence of adrenal cortices; autoimmune
• Weakness, weight loss, N/V, and pain, little axillary hair, hyper pigmentation in creases and pressure points, hypotension
• Increased K and decreased Na
• Cosyntropin unable to raise cortisol
• Hydrocortisone; Aldosterone replaced with fludrocortisone

Answer 6

Chronic (primary) Adrenal Insufficiency

Addison Disease