Adrenal Gland Pathology

Question 1

Rapid cessation of chronic high-dose glucocorticoids can cause _______(type) adrenal insufficiency.

Answer 1

tertiary

Question 2

What is Conn’s Syndrome?

Answer 2

primary hyperaldosteronism

HTN, hypokalemia, and metabolic alkalosis

Question 3

cosyntropin is a synthetic ______ analog

Answer 3

ACTH

Question 4

a high Aldosterone: Renin ratio is indicative of ______

Answer 4

hyperaldosteronism

Question 5

low dexamethasone suppression test is used for diagnosis of ______

Answer 5

Cushing’s syndrome;

dexamethasone is “cortisol like”

Question 6

what is the screening test of hyperaldosteronism (Conn’s Syndrome)

Answer 6

↑ Aldosterone: Renin ratio

Question 7

how can you tell the difference between a pituitary source of ACTH vs an ectopic source of ACTH?

Answer 7

do a high dose dexamethose suppression test;

if the suppressed cortisol level is LESS THAN 50% of baseline → PITUITARY source of ACTH

Question 8

what is the diagnostic test used to confirm primary hyperaldosteronism

Answer 8

fludrocortisone suppression test

Question 9

the highest concentration of ACTH and cortisol is in the ______ (time of day) and lowest at _______ (time of day)

Answer 9

highest in the morning and lowest at night

Question 10

a person presents with hypokalemia, metabolic alkalosis, HTN.
what would you do to tell the difference between primary and secondary hyperaldosteronism?

Answer 10

primary: low renin
secondary: high renin

Question 11

what is the effect to cortisol on proteins, lipids and carbs?

Answer 11

proteins: ↑ degradation
lipids: ↑ lipolysis
carbs: ↑ gluconeogenesis and antagonizes insulin

has WEAK mineralcorticoid properties

Question 12

Persistently elevated cortisol in response to low-dose dexamethasone, but reduced cortisol levels in response to high-dose dexamethasone is likely due to _________

Answer 12

an ACTH-secreting pituitary adenoma (Cushing’s Disease)

Question 13

cortisol is pro/anti inflammatory?

Answer 13

anti-inflammatory

Question 14

a person’s is suspected of having Cushing’s syndrome. The dexamethasone suppression test showed that he had very low levels of cortisol in the morning after taking dexamethasone at 11pm the night before. Does this finding confirm the diagnosis?

Answer 14

NO; normal individual will have low cortisol levels but in patients with Cushing’s, there is NO CORTISOL SUPPRESSION

Question 15

the adrenal medulla is composed of _______ cells

Answer 15

chromaffin cells which secrete catecholamines (mainly epinephrine)

Question 16

fludrocortisone suppression test is a diagnostic test for ______

Answer 16

hyperaldosteronism;

in normal people fludrocortisone will suppress aldosterone production but in patients with primary aldosteronism, it is NOT SUPPRESSED