Adrenal Glands

Question 1

What are the layers of the adrenal cortex from out to in and what do they secrete

Answer 1

Glomerulosa - Aldosterone
Fasciculata - Cortisol
Reticularis - weak Androgen

Question 2

What is cushing SYNDROME

Answer 2

Ectopic supply of ACTH or similar substance increasing adrenal secretion of cortisol

Question 3

What is cushing DISEASE

Answer 3

Pituitary source of high ACTH secretion

Question 4

What are the gross features of an adrenal cortical adenoma

Answer 4

well circumscribed and yellow ball in one area

this compared to secondary hyperadrenalism which makes the entire cortex hypertrophic

Question 5

what would occur to the cortisol level if you gave high dose dexamethasone to someone with a pituitary adenoma causing cushing disease

Answer 5

it would be suppressed

Question 6

what is the classic triad of Primary hyperaldosteronism (Conn’s disease)

Answer 6

HTN
Hypokalemia
Hypomagnesemia

Question 7

What are the characteristics of an aldosterone secreting adenoma

Answer 7

Small
Young pts
Spironolactone bodies
High incidence of ischemic hear disease

Question 8

What causes most cases of congenital adrenal hyperplasia

Answer 8

deficiency in 21-hydroxylase

Question 9

What occurs in salt wasting syndrome

Answer 9

Lack of 21-hydroxylase ->

no salt retention
hyperkalemia
hypotension

Question 10

how would you classify someone with precocious puberty with acne and hirsutism

Answer 10

late onset adrenal virilism from later 21-hydroxylase deficiency

Question 11

what is the therapy for congenital adrenal hyperplasia

Answer 11

glucocorticoids

Question 12

prolonged use of corticosteroids can lead to what effect on adrenals

Answer 12

atrophy

Question 13

what is the triad of adrenal crisis

Answer 13

Hypotension
Hyponatremia
Hyperkalemia

Question 14

If a kid with N. meningitidis develops adrenal insufficiency what occurred and what is it called

Answer 14

adrenal hemorrhage

Waterhouse-Friderichsen syndrome

Question 15

what are signs and symptoms of acute adrenal insufficiency

Answer 15

Hypotension
Abd pain
Fever
N./V
Hyponatremia
Hypoglycemia

Question 16

What are the signs and sx of primary chronic adrenocortical insufficiency

Answer 16

Malaise, fatigue
Anorexia and weight loss
Joint pain
Hyperpigmentation of skin

Question 17

What is nelson syndrome

Answer 17

Someone who has cushing disease and their adrenals removed. keeps ACTH high with no product -> chronic insufficiency

Question 18

What are the most common causes of primary adrenal insufficiency in the developed world, undeveloped world, and the whole world

Answer 18

Developed and whole world, Autoimmune

Developing, TB

if there is a question about most common cause go autoimmune

Question 19

Describe Autoimmune polyendocrine syndrome 1

Answer 19

Mutation in AIRE

Adrenalitis
Parathyroiditis
Hypogonadism
Pernicious anemia
Candida 
ECTODERMAL DYSTROPHY

Question 20

What classifies adrenal cortical carcinoma

Answer 20

Its HUGE and its lumpy >200 gm

Question 21

List the 10% rule of pheochromocytoma

Answer 21

10% extra-adrenal
10% bilateral
10% in kids
10% malignant
10% NOT associated with HTN

25% are familial

Question 22

What is the classic triad of pheochromocytoma

Answer 22

Headache
Palpitations
Diaphoresis

Question 23

How do you diagnose pheochromocytoma

Answer 23

measure catecholamine metabolites in blood and urine

-Normetanephrine/metanephrine

Question 24

what is a myolipoma

Answer 24

Benign tumor of fat and bone - can bleed

Question 25

What are the three Ps of MEN1 (germline MEN1 tumor suppressor)

Answer 25

Primary hyperparathyroidism 
Pancreatic endocrine tumors
Pituitary adenomas (lactotroph/somatotroph)

Question 26

What categorizes MEN 2A (germline GoF in RET proto-onco)

Answer 26

Pheochromocytoma
MEdullary thyroid carcinoma
Parathyroid hyperplasia

Question 27

What categorizes MEN 2B (point mutation RET proto-onco)

Answer 27

Medullary thyroid carcinoma
Pheochromocytoma
Mucosal Neuromas
Marfanoid body habitus