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Endocrine II AH > Adrenal Gland Red Highlights - Newman > Flashcards

Adrenal Gland Red Highlights - Newman Flashcards

1
Q

Main signs in primary Adrenal Insufficiency?

A

Skin hyperpigmentation
Salt craving
Increased ACTH

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2
Q

Imaging for ACTH-independent Cushing Syndrome?

Dependent?

A

CT of adrenals

MRI of pituitary

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3
Q

Low serum ACTH in the setting of low serum cortisol indicates what?

What sx?

A

Secondary adrenal insufficiency

Alabaster skin

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4
Q

Addison’s disease results in decreased what?

Despite increased what?

A

DEC mineralcorticoids, glucocorticoids, and androgens

ACTH

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5
Q

ACTH-independent Cushing Syndrome causes?

A

Exogenous corticosteroid use

Adrenocortical tumor

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6
Q

What are the 3 causes of adrenal insufficiency in order of most to least common?

A
  1. Adrenal destruction
  2. Adrenal dysgenesis
  3. Impaired steroidogenesis
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7
Q

NE causes what sx?

Epi?

A

HTN

tachyarrythmias

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8
Q

What should you test for in pts w/HTN and hypokalemia, severe HTN, early onset HTN, or tx-resistant HTN?

A

Primary aldosteronism

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9
Q

Pheos secrete what?

Paragangliomas?

A

Epi and NE

Only NE

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10
Q

What is the tx for adrenal insufficiency?

A

Glucocorticoid replacement therapy: hydrocortisone, prednisone, prednisolone
Mineralcorticoid replacement therapy: fludrocortisone, acute (Na sparing)
DHEA: give to some women

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11
Q

Pheochromacytomas and paragangliomas are tumors of what?

A

Sympathetic nervous system

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12
Q

Imaging of pheo if suspected?

A

noncontrast CT of abdomen

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13
Q

Inheritance of VHL type 2?

Major clinical features?

A

AD

Hemangioma of retina, cerebellum, brainstem
Pheos

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14
Q

How do you treat Acute Adrenal crisis?

A

Hydrocortisone

Fluids

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15
Q

What are discovered incidentally on abdominal CT or MRI?

When should they be resected?

A

Adrenal nodules –> adrenal incidentaloma

> 4cm

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16
Q

During surgery of pheos and paragangliomas the abdomen can be seeded and result in multifocal recurrent intra-abdominal tumors, what is this called?

A

Pheochromocytomatosis

17
Q

MEN syndromes inheritance?

A

AD

18
Q

What is the confirmatory test in primary adrenal insufficiency?

A

Cosyntropin (synthetic ACTH) stimulation test

If cortisol levels do not respond to cosyntropin admin, it confirms AI

19
Q

Diagnosis?

Cortisol high
ACTH low

A

Tumor in adrenal gland

20
Q

Diagnosis?

Cortisol low
ACTH high

A

Damage to the adrenal gland

21
Q

What is impaired in Cushing syndrome?

What may indicate Cushing syndrome?

Easiest screening test?

A

Glucose tolerance

Elevated midnight cortisol levels

Dexamethasone suppression test

22
Q

If the ACTH is elevated in the hundred and the cortisol is NOT suppressed by high or low doses by dexamethasone, what does it mean?

A

Ectopic ACTH syndrome

23
Q

If the ACTH is undetectable or low and cortisol is NOT suppressed by high or low doses, what is the interpretation?

A

Primary hypercortisolism is likely

24
Q

Medical tx prior to resection of pheo?

A

Alpha-blocker –> Phenoxybenzamine

25
Q

Main ACTH-dependent Cushing syndrome?

A

Cushing disease

Small cell carcinoma of the lung

26
Q

All patients (even normotensive) w/an adrenal incidentaloma require testing for what?

A

Pheochromocytoma w/metanephrines

27
Q

What accounts for adrenal destruction in Addison’s disease?

A

1 autoimmune

X-linked recessive disorder
Infection –> TB
B/l adrenal hemorrhage

28
Q

Diagnosis?

Cortisol high
ACTH high

A

Tumor in anterior pituitary

29
Q

All pts w/biochemically confirmed primary aldosteronism require what?

A

Thin-section CT scan of the adrenals to screen for adrenal carcinoma

30
Q

Can surgical histopathology for pheos determine malignancy?

A

NO

31
Q

In 21-hydroxylase deficiency, what is required for diagnosis?

A

Elevated serum levels of 17-OH progesterone

32
Q

Diagnosis?

Cortisol low
ACTH low

A

Hypopituitary adrenal insufficiency

33
Q

What is the single most sensitive test for secretory pheos and paragangliomas?

What is elevated in serum 90% of the time?

A

Plasma fractionated free metanephrines

Serum chromogranin A (CgA)

34
Q

Female infants w/21-hydroxylase deficiency will have what?

A

Virilized genitalia

35
Q

What accounts for adrenal dysgenesis?

A

Familial glucocorticoid deficiency (AR)

Less important: Triple A (Allgrove syndrome) and congenital adrenal hypo-plasma

36
Q

What causes inappropriately high aldosterone secretion that does not suppress adequately w/sodium loading?

A

Primary aldosteronism

37
Q

Conn syndrome pts have primary aldosteronism secondary to what?

40% have a mutation in what?

What complications frequently occur?

A

Unilateral aldosterone-producing adrenal adenoma

Gene coding for K+ channel

CVA

38
Q

What accounts for impaired steroidogenesis?

A

CAH

Smith-Lemli-Opitz (cholesterol biosynthesis disorder)

Endocrine II AH (6 decks)

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