Adrenal gland pathology pt 1

Question 2

who secretes Adrenocorticotropic hormone (ACTH)?

who regulates its release?

what does ACTH stimulate?

what does ACTH stimulate the release of?

Answer 2

Secreted by anterior pituitary

CRH ( corticotropin releasing hormone)

growth of adrenal cortex

• Glococorticoids (mainly)
• Andogens and
• Mineralocorticoids (to a very limited extent)
• melanocyte stimulating property

Question 3

what are the 2 parts of the Adrenal gland?

Answer 3

• Adrenal cortex: Disorders of adrenal cortex
• Adrenal medulla: Disorders of adrenal medulla

Question 4

what are the Adrenal cortex’s 3 regions?

what are the steroids it releases?

Answer 4

Zona glomerulosa = mineralocorticoids

Zona fasciculata = Glucocorticoids (cortisol)

Zona reticularis = Sex steroids (androgens)

Question 5

Diseases of adrenal cortex are related to what 2 things?

Answer 5

• Associated with hyperfunction
• Associated with hypofunction tumors

Question 6

what is another name for Adrenal cortex hyperfunction?

what are the Three different hyper-adrenal syndromes?

Answer 6

hyperadrenalism

1. Excess of aldosterone = Hyperaldosteronism
2. Excess of cortisol = Cushing’s syndrome
3. Excess of androgens = Adrenogenital syndrome.

Question 7

what is cushings syndrome?

Answer 7

Caused by any condition that produces chronic elevation in cortisol levels.

Question 8

what are the roles of cortisol?

Answer 8

• A glucocorticoid
• Involved in regulation of metabolism
• Counteracts the action of insulin
• Supports blood pressure and vasomotor tone
• Also involved in regulation of behavior and immunosuppression.

Question 9

fill the blanks

Answer 9

Question 11

what does cushings syndrome cause?

Answer 11

1. Prolonged corticosteroid therapy
2. Pituitary Cushing syndrome (Cushings disease)
3. Adrenal Cushing syndrome
4. Ectopic Cushing syndrome

Question 12

Pituitary Cushing syndrome is usually caused by what?

what does it lead to?

Answer 12

pituitary adenoma

increased ACTH and cortisol

Question 13

what is the most common cause for adrenal cushings?

what will be the findings?

Answer 13

adrenal adenoma producing cortisol

Decreased ACTH and increased cortisol

Question 14

what is the most common cause for Ectopic Cushing syndrome?

what do you look for?

Answer 14

small cell carcinoma of lung producing Ectopic ACTH

Markedly increased** ACTH and cortisol

Question 15

what are the clinical findings for cuhsing syndrome?

Answer 15

1. Weight gain
2. Thin extremities
3. Purple abdominal striae
4. Glucose intolerance/diabetes
5. Hypertension
6. Hirsutism
7. Osteoporosis
8. Plethoric face, menstrual irregularities, acne, easy bruisability, depression and insomnia. Cutaneous hyperpigmentation.

Question 16

why do you see weight gain in cushings syndrome?

Answer 16

hyperinsulinism from hyperglycemia

Insulin increases storage of fat (Triglycerides) in adipose

Question 17

what areas of the body will see an increase of fat deposition leading to weight gain in cushing syndrome?

Answer 17

• Face = moon facies
• Upper back = buffalo hump and
• Trunk (truncal obesity) with sparing of limbs.

Question 18

why will you see thin extremities in cushing syndrome?

Answer 18

Cortisol breaks down muscles in the extremities

Question 19

in cushing syndrome, why will you see purple abdominal striae?

Answer 19

• Cortisol weakens collagen.
• Causes rupture of vessels in stretch marks

Question 20

why will you see hypertension in cushing syndrome?

and Hirsutism?

and Osteoporosis?

Answer 20

Cortisol up regulates alpha 1 receptors on arterioles.

Due to increase in androgens

Cortisol causes increased breakdown of bone

Question 21

what Laboratory findings can be obtained from a cushings symdrome patient?

Answer 21

• Free Urine cortisol : increased (best screening test)
• Serum cortisol: Increased
• Plasma ACTH:
  
  • Low in Adrenal Cushing
  • Very high in Ectopic Cushing
  • Normal to slightly increased in Pit Cushing.
• Low dose Dexamethasone suppression test:
  
  • cannot suppress cortisol in any type of Cushing.

Question 22

what is Hyperaldosteronism?

what will it lead to?

Answer 22

Group of closely related disorders characterized by excess aldosterone secretion.

Na retention & K excretion –>  hypertension and Hypokalemia.

Question 23

Hyperaldosteronism may be of 2 types?

Answer 23

1. Primary (Conn’s syndrome)
2. Secondary

Question 24

primary hyperaldosteronism is mainly caused by what?

Answer 24

Most commonly due to aldosterone producing benign adenoma in zona glomerulosa.

Question 25

what are the Clinical findings for 1ry hyperaldosteronism?

Answer 25

• Hypertension (Na retention)
• Muscle weakness (hypokalemia)
• Tetany (alkalosis ↓ the ionized calcium levels).
• Polyuria, polydipsia secondary to hypokalemic nephropathy (Nephrogenic DI).

Question 26

what will be the Laboratory findings for 1ry hyperaldosteronism?

Answer 26

• Hypernatremia
• Hypokalemia
• Increased plasma aldosterone level.
• Decreased plasma renin activity* ( due to negative feedback of increased BP on renin secretion)
• Metabolic alkalosis