Adrenal Glands - Sheet1 Flashcards
↑ cortisol caused by a pituitary adenoma resulting in ↑ ACTH secretion which causes the adrenal gland to secrete excess cortisol
Cushing’s Disease: secondary
↑ cortisol secretion from an adrenal tumor
Cushing’s Syndrome: primary
Adrenal gland destruction causing lack of cortisol and aldosterone secretion usually autoimmune
Primary adrenocortical insufficiency (Addison’s disease)
In a patient with secondary corticoadrenal insufficiency, what would happen to cortisol levels after a cosyntropin stimulation?
Cortisol levels would increase
What is cosyntropin?
ACTH
What does no change in cortisol levels after initiation of a cosyntropin stimulation indicate?
Primary corticoadrenal insufficiency
How does hyperpigmentation differentiate hypocortisol states?
Hyperpigmentation occurs with primary corticoadrenal insufficiency (Addison’s disease)
What is the treatment of choice for Cushing’s Disease?
Trans sphenoidal resection of the pituitary adenoma or surgical resection of ectopic cortisol producing tumor and cortisol (hydrocortisone or fludrocortisone) replacement if needed
What are the cardinal signs and symptoms of Cushing syndrome or disease?
Buffalo hump - Moon face - Blue abdominal striae - Truncal obesity - Hyperglycemia - Hypertension
Salt craving hyperpigmentation of skin and fatigue represent which disorder?
Addison’s
Pheochromocytoma
24 hour catecholamines including metabolites (metanephrine and vanillylmandelic acid)
List three medications which may be used for Cushing patients who can not have surgical correction?
Mitotane - Metyrapone - Ketoconazole
What screening should long term Cushing syndrome or disease patients have?
DEXA (Osteoporosis common in long term hyper-cortisol states)
Decreased ACTH and high cortisol levels in a high dose dexamethasone suppression test is diagnostic for which disorder?
Cushing syndrome (primary) will result in decreased ACTH from the dexamethasone
Increased ACTH result from a high dose dexamethasone suppression test is diagnostic for which disorder?
Cushing disease (secondary) will continue with increased ACTH despite the dexamethasone
What result is expected with a low dose dexamethasone suppression test?
Decreased cortisol = Normal - Cushing disease or syndrome will result in persistent increased cortisol
Cushing Syndrome
Buffalo hump, moon face, blue abdominal striae, truncal obesity, increased glucose, increased BP
List three causes of Cushing syndrome?
Adrenal adenoma - Adrenal hyperplasia - Adrenal cancer
Is Cushing’s disease or syndrome more common?
70% of patients have secondary (Cushing’s disease) from ACTH secreting tumors
What test other than the dexamethasone suppression test can be used for Cushing disease?
Serum ACTH will be increased in Cushing’s disease (secondary)
What test other than the dexamethasone suppression test can be used for Cushing syndrome or disease?
24 hour urine for cortisol will be increased in both
What is the difference between Cushing syndrome and Cushing’s disease?
Syndrome is primary - Disease is secondary
What happens to glucose blood pressure inflammation and metabolism in Cushing’s syndrome or disease?
Increased glucose - Increased blood pressure - Decreased inflammation - Increased metabolism
PITUITARY FAILURE which results in ↓ ACTH (from pituitary failure), ↓ Cortisol, and normal aldosterone
Secondary adrenocortical insufficiency (Addison’s disease)
What is the treatment for corticoadrenal insufficiency?
Hydrocortisone or fludrocortisone
List four less common causes of primary corticoadrenal insufficiency?
Tuberculosis - Adrenal infection - Metastasis to adrenal gland - Adrenal trauma
What is the most common cause of primary corticoadrenal insufficiency?
Addison’s disease
What symptoms may result from abrupt withdrawal of long term high dose steroids?
Severe N/V/D - Significant hyponatremia - Hyperkalemia - Hypoglycemia
A test in which one or more small doses of dexamethasone are given. The level of cortisol is checked from a sample of blood or from urine that is collected for three days. This test is done to check if the adrenal gland is making too much cortisol. In general, a clear failure to suppress cortisol levels in response to low-dose dexamethasone establishes the diagnosis.
Low-dose dexamethasone suppression test - used to diagnose cushing’s syndrome
A test in which one or more high doses of dexamethasone are given. The level of cortisol is checked from a sample of blood or from urine that is collected for three days.
High-dose dexamethasone suppression test (done in response to a positive low dose test)
A patient has decreased ACTH and increased cortisol. Is this primary or secondary disease?
Primary
What basic metabolic panel finding might one find in a patient with Addison’s disease?
Hyponatremia
What CBC finding might one find in a patient with Addison’s disease?
Eosinophilia
What are you concerned about in a patient who has no change in ACTH levels and has increased cortisol levels on a high dose dexamethasone suppression test?
Ectopic source of ACTH - e.g. lung tumor
What is the best way to test cortisol levels in a patient with a suspect hypercortisol state?
24 hour urine cortisol
Are increased cortisol levels with a cosyntropin test consistent with primary or secondary corticoadrenal insufficiency?
Secondary
Is hyperpigmentation a sign of primary or secondary corticoadrenal insufficiency?
Primary
What is Sipple syndrome?
MEN 2a (Hyperparathyroid - Medullary thyroid cancer - Pheochromocytoma)
