Adrenal Glands - Sheet1

Question 1

↑ cortisol caused by a pituitary adenoma resulting in ↑ ACTH secretion which causes the adrenal gland to secrete excess cortisol

Answer 1

Cushing’s Disease: secondary

Question 2

↑ cortisol secretion from an adrenal tumor

Answer 2

Cushing’s Syndrome: primary

Question 3

Adrenal gland destruction causing lack of cortisol and aldosterone secretion usually autoimmune

Answer 3

Primary adrenocortical insufficiency (Addison’s disease)

Question 4

In a patient with secondary corticoadrenal insufficiency, what would happen to cortisol levels after a cosyntropin stimulation?

Answer 4

Cortisol levels would increase

Question 5

What is cosyntropin?

Answer 5

ACTH

Question 6

What does no change in cortisol levels after initiation of a cosyntropin stimulation indicate?

Answer 6

Primary corticoadrenal insufficiency

Question 7

How does hyperpigmentation differentiate hypocortisol states?

Answer 7

Hyperpigmentation occurs with primary corticoadrenal insufficiency (Addison’s disease)

Question 8

What is the treatment of choice for Cushing’s Disease?

Answer 8

Trans sphenoidal resection of the pituitary adenoma or surgical resection of ectopic cortisol producing tumor and cortisol (hydrocortisone or fludrocortisone) replacement if needed

Question 9

What are the cardinal signs and symptoms of Cushing syndrome or disease?

Answer 9

Buffalo hump - Moon face - Blue abdominal striae - Truncal obesity - Hyperglycemia - Hypertension

Question 10

Salt craving hyperpigmentation of skin and fatigue represent which disorder?

Answer 10

Addison’s

Question 11

Pheochromocytoma

Answer 11

24 hour catecholamines including metabolites (metanephrine and vanillylmandelic acid)

Question 12

List three medications which may be used for Cushing patients who can not have surgical correction?

Answer 12

Mitotane - Metyrapone - Ketoconazole

Question 13

What screening should long term Cushing syndrome or disease patients have?

Answer 13

DEXA (Osteoporosis common in long term hyper-cortisol states)

Question 14

Decreased ACTH and high cortisol levels in a high dose dexamethasone suppression test is diagnostic for which disorder?

Answer 14

Cushing syndrome (primary) will result in decreased ACTH from the dexamethasone

Question 15

Increased ACTH result from a high dose dexamethasone suppression test is diagnostic for which disorder?

Answer 15

Cushing disease (secondary) will continue with increased ACTH despite the dexamethasone

Question 16

What result is expected with a low dose dexamethasone suppression test?

Answer 16

Decreased cortisol = Normal - Cushing disease or syndrome will result in persistent increased cortisol

Question 17

Cushing Syndrome

Answer 17

Buffalo hump, moon face, blue abdominal striae, truncal obesity, increased glucose, increased BP

Question 18

List three causes of Cushing syndrome?

Answer 18

Adrenal adenoma - Adrenal hyperplasia - Adrenal cancer

Question 19

Is Cushing’s disease or syndrome more common?

Answer 19

70% of patients have secondary (Cushing’s disease) from ACTH secreting tumors

Question 20

What test other than the dexamethasone suppression test can be used for Cushing disease?

Answer 20

Serum ACTH will be increased in Cushing’s disease (secondary)

Question 21

What test other than the dexamethasone suppression test can be used for Cushing syndrome or disease?

Answer 21

24 hour urine for cortisol will be increased in both

Question 22

What is the difference between Cushing syndrome and Cushing’s disease?

Answer 22

Syndrome is primary - Disease is secondary

Question 23

What happens to glucose blood pressure inflammation and metabolism in Cushing’s syndrome or disease?

Answer 23

Increased glucose - Increased blood pressure - Decreased inflammation - Increased metabolism

Question 24

PITUITARY FAILURE which results in ↓ ACTH (from pituitary failure), ↓ Cortisol, and normal aldosterone

Answer 24

Secondary adrenocortical insufficiency (Addison’s disease)

Question 25

What is the treatment for corticoadrenal insufficiency?

Answer 25

Hydrocortisone or fludrocortisone

Question 26

List four less common causes of primary corticoadrenal insufficiency?

Answer 26

Tuberculosis - Adrenal infection - Metastasis to adrenal gland - Adrenal trauma

Question 27

What is the most common cause of primary corticoadrenal insufficiency?

Answer 27

Addison’s disease

Question 28

What symptoms may result from abrupt withdrawal of long term high dose steroids?

Answer 28

Severe N/V/D - Significant hyponatremia - Hyperkalemia - Hypoglycemia

Question 29

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.

Answer 29

Low-dose dexamethasone suppression test - used to diagnose cushing’s syndrome

Question 30

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.

Answer 30

High-dose dexamethasone suppression test (done in response to a positive low dose test)

Question 31

A patient has decreased ACTH and increased cortisol. Is this primary or secondary disease?

Answer 31

Primary

Question 32

What basic metabolic panel finding might one find in a patient with Addison’s disease?

Answer 32

Hyponatremia

Question 33

What CBC finding might one find in a patient with Addison’s disease?

Answer 33

Eosinophilia

Question 34

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?

Answer 34

Ectopic source of ACTH - e.g. lung tumor

Question 35

What is the best way to test cortisol levels in a patient with a suspect hypercortisol state?

Answer 35

24 hour urine cortisol

Question 36

Are increased cortisol levels with a cosyntropin test consistent with primary or secondary corticoadrenal insufficiency?

Answer 36

Secondary

Question 37

Is hyperpigmentation a sign of primary or secondary corticoadrenal insufficiency?

Answer 37

Primary

Question 38

What is Sipple syndrome?

Answer 38

MEN 2a (Hyperparathyroid - Medullary thyroid cancer - Pheochromocytoma)