adrenal glands

Question 1

short term stress response on body

Answer 1

increased heart rate
increase blood pressure
liver convert glycogen to glucose and release it in blood
changes in blood flow –> decrease digestion activity
increase metabolic rate

Question 2

LONG term stress response on body

Answer 2

• Retention of Na and water by kidney
• increase blood volume and blood pressure
• protien and fats converted to glucose for energy
• increase blood glucose
• suppresed immune system

Question 3

HPA axis (Hypothalamic-pituitary-adrenal

Answer 3

CRH (Corticotropin-releasing hormone) is secreted by the hypothalamus
and
stimulates secretion of ACTH (adreno-corticotropic hormone) from the pituitary gland.

Question 4

Adrenal insufficiency definition

Answer 4

“the inability of the adrenal glands to produce adequate amounts of cortisol for normal physiologic functioning or in times of stress”

Question 5

3 types of adrenal insufficiency exist:

Answer 5

1. primary(adison disease): due to autommine and tb
2. secondary: due to pitutary gland dysfuntion ( surgery, irradiation, traumatic brain injury)
3. tertiary: due to hypothalamus dysfuntion

Question 6

sign and symtoms of adrenal insuffiency

Answer 6

1. Physical Symptoms: (Weakness, weightloss, fatigue, vitiligo, body hair loss, cold intolerance Hyperpigmentation,)
2. gastointestinal: anorexia, abdominal pain, vomit, diarrhea, nausea)
3. psycological: depression, personality changes, memory impair
4. dieasese: hypoglycemia, hypotention, fever, amenorhea

Question 7

diagnosis of adrenal insufficiency lab tests

Answer 7

1. cortisol tests: decrease in basal and stress related cortisol
2. aldoestron: decrease levels
3. cosyntropin stimulation test: : lack of increase in aldoestreon and cortisol level after acth stimulation.
4. plasma ACTH conc.

Question 8

diagnosis of adrenal insufficiency oother tests

Answer 8

CT scan or MRI of the adrenal glands, pituitary, and/or hypothalamus can aid in determining etiology.
Presence of antiadrenal antibodies is suggestive of an autoimmune etiology.

Question 9

what are the glucocorticoids meds:

and which is preffered and why?

Answer 9

Hydrocortisone, cortisone, prednisolone, and dexamethasone.

hydrocortisone preffered bcz:
It closely resembles endogenous cortisol with its high mineralocorticoid activity and short half-life, allowing regimens that simulate the normal daily cycle.

Question 10

What is the recommended starting daily dose for hydrocortisone?
and when to administer the dose

Answer 10

15–25 mg daily (or equivalent cortisone or prednisone).

Two-thirds of the dose in the morning, and one-third 6–8 hours later.

Question 11

when is glucocorticoids monitor in therpay and wht are the things to monitor?

Answer 11

Regular check-ups every 6-8 weeks.

Monitoring includes:
* Body weight.
* Blood pressure (BP).
* Electrolytes.
* Assessing symptom resolution and general well-being.

Question 12

What is the primary treatment for mineralocorticoid replacement in Addison’s Disease and dose?

Answer 12

Fludrocortisone acetate.
0.05–0.2 mg orally, once daily.

Question 13

Q: What is the alternative parenteral therapy for adrenal insufficiency when oral treatment isn’t possible?

Answer 13

A: Deoxycorticosterone trimethylacetate.

A: 2–5 mg every 3 to 4 weeks.

Question 14

Q: What causes acute adrenal insufficiency (adrenal crisis)?

Answer 14

The body’s inability to increase cortisol levels during stress, often in patients with chronic adrenal insufficiency during surgery, infection, trauma, or after abrupt glucocorticoid discontinuation. It can also result from bilateral adrenal infarction (hemorrhage, embolus, thrombosis).

Question 15

Q: What are the symptoms of acute adrenal insufficiency?

Answer 15

Severe weakness, fatigue, abdominal pain, severe dehydration, hypotension, shock, hypovolemia, tachycardia, nausea, vomiting, fever, confusion, and hypoglycemia.

Question 16

hydrocortisone in adrenal crisis: initial dose and continue admin

Answer 16

• Initial dose: 100 mg IV as a rapid infusion.
• Continued administration: Either as a continuous infusion (10 mg/h) or intermittent boluses (100-200 mg/day).
• After 24-48 hours of IV hydrocortisone, if stable, switch to oral hydrocortisone (50 mg every 6-8 hours), then taper based on the patient’s chronic needs.

Question 17

Q: How is acute adrenal insufficiency diagnosed?

Answer 17

A: Diagnosis is confirmed with an unstimulated serum cortisol test and a rapid ACTH stimulation test.

Question 18

treatment of adrenal crisis how to treat hyperkalemia

Answer 18

If hyperkalemia persists after hydrocortisone, add fludrocortisone acetate 0.1 mg daily for mineralocorticoid support.

Question 19

fluid replacement in adrenal crisis

Answer 19

Large volumes of IV normal saline (NS) and 5% dextrose (~2-3 L) to maintain blood pressure.

Question 20

prevention of adrenal crisis

Answer 20

• Add 5 - 10 mg hydrocortisone (or equivalent) to the normal daily regimen shortly before strenuous activities, such as exercise.
• During times of severe physical stress (e.g. fever, accidents or patients undergoing invasive dental or diagnostic procedures), patients should be instructed to double the daily dose until recovery.

Question 21

Endogenous hypercortisolism

Answer 21

Endogenous hypercortisolism: caused by exposure to supraphysiologic cortisol concentrations.

Question 22

Exogenous hypercortisolism:

Answer 22

Exogenous hypercortisolism: caused by exposure to pharmacologic doses of glucocorticoids.

Question 23

Pathophysiology & Causes of Hypercortisolism
acth dependent

Answer 23

1. Cushing Disease(ACTH-secreting pituitary tumor) - 70% of cases.
2. Ectopic ACTH Syndrome (ACTH-secreting non-pituitary tumors) - 15% of cases.
   Tumors are usually hard to find, e.g. in small cell lung cancer, bronchial carcinoids, or other organs like the pancreas or ovaries.
3. Ectopic CRH Syndrome (CRH-secreting tumors) - rare.

Question 24

ACTH-Independent
Causes of Hypercortisolism

Answer 24

15% of endogenous cases

• Unilateral adrenal adenoma (benign tumor).
• Adrenal carcinoma (cancerous tumor).
• Bilateral nodular adrenal hyperplasia (rare <1%).

Question 25

Drug-Induced Cushing Syndrome

Answer 25

• Prescription glucocorticoid
• Nonprescription and herbal products (e.g. nonprescription anti-pruritus products with hydrocortisone, herbal products with magnolia bark)
• Other drugs with glucocorticoid activity (e.g. megestrol acetate, medroxyprogesterone)

Question 26

Laboratory Tests
and other test for diagnosis of hypercortsolism

Answer 26

• 24-hr urinary free cortisol: elevated in hypercortisolism
• Overnight dexamethasone suppression test – normally dexamethasone suppresses morning plasma cortisol - elevated in hypercortisolism
• Midnight plasma cortisol: elevated in hypercortisolism
• Late-night salivary cortisol: elevated in hypercortisolism
  **Other tests: to determine etiology:
  **
• Plasma ACTH test
• Adrenal vein catheterization
• Metyrapone stimulation test
• Adrenal, chest, or abdominal CT scan
• CRH stimulation test
• Inferior petrosal sinus sampling
• Pituitary MRI

Question 27

cushing syndrome non pham treatment

Answer 27

• Surgical resection is the first-line treatment for endogenous hypercortisolism, especially when a tumor can be located and removed.
• Radiation therapy is an option for patients who can’t have surgery, have had a relapse, or didn’t fully recover after surgery.
• For exogenous Cushing syndrome, the best treatment is gradually discontinuing the glucocorticoid, with
  tapering to avoid adrenal crisis.

Question 28

drugs for cuhsing syndrome

Answer 28

1. Adrenal Steroidogenesis Inhibitors (e.g., Metyrapone, Ketoconazole, Etomidate)
2. Adrenolytic Agents (e.g., Mitotane):
3. Peripheral Glucocorticoid Antagonist (e.g., Mifepristone):
4. Somatostatin Analog (e.g., Pasireotide):