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ENDOCRINE > ADRENAL INSUFFICIENCY > Flashcards

ADRENAL INSUFFICIENCY Flashcards

1
Q

where are the adrenal glands located?

A

they sit at the superior poles of the kidneys

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2
Q

what do the adrenal glands consist of?

A
  1. adrenal medulla
  2. adrenal cortex
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3
Q

what is the adrenal medulla, and what does it secrete?

A

its the inner portion of the adrenal gland
responds to sympathetic stimulation by secreting catecholamines (epinephrine and norepinephrine)

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4
Q

what does the adrenal cortex consist of?

A

its the thick outer portion
consists of 3 layers
1. zona glomerulosa (outer)
2. zona fasciculata (middle)
3. zona reticularis (inner)

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5
Q

what does the adrenal cortex do?

A

synthesizes 25 steroid hormones that are collectively known as corticosteroids

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6
Q

what are mineralcorticoids secreted by?

A

zona glomerulosaw

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7
Q

what do mineralcorticoids control?

A

electrolyte balance by acting on the kidneys

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8
Q

what is the main mineralcorticoid?

A

aldosterone

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9
Q

what are glucocorticoids secreted by?

A

zona fasciculata

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10
Q

what is the main glucocorticoid?

A

cortisol

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11
Q

what do glucocorticoids do?

A
  1. stimulate fat and protein catabolism
  2. gluconeogenesis (the synthesis of glucose from non-carbohydrate sources) in the liver
  3. release of fatty acids and glucose into the blood
  4. help the body adapt to stress
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12
Q

what is aldosterone?

A

part of a hormone family with renin and angiotensin

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13
Q

why is aldosterone secreted?

A

its secreted directly in response to hyperkalemia and via the RAA system in response to low blood volume/low blood pressure

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14
Q

what is adrenal insufficiency?

A

inadequate production of adrenocortical hormones -> glucocorticoids (cortisol), mineralcorticoids (aldosterone), and adrenal androgens

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15
Q

what are the types of adrenal insufficiency?

A
  1. primary
  2. secondary
  3. tertiary
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16
Q

what is primary adrenal insufficiency?

A

addison’s disease
dysfunction or destruction of the adrenal cortex

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17
Q

what is secondary adrenal insufficiency?

A

conditions that cause deficiency in pituitary ACTH secretion
MOST COMMON FORM

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18
Q

what is tertiary adrenal insufficiency?

A

conditions that cause deficiency in the hypothalamic secretion of CRH

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19
Q

is addisons disease autoimmune?

A

yes

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20
Q

what is the most common cause of adrenal insufficiency (70% of cases are this)?

A

autoimmune
(addison’s)

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21
Q

what happens in autoimmune (primary disease) of adrenal insufficiency?

A

adrenal cortex is gradually destroyed leading to loss of mineralcorticoids, glucocorticoids, and adrenal androgen hormone production

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22
Q

minus the autoimmune aspect what is the second most common cause of primary adrenal insufficiency?

A

infection! TB

23
Q

hemorrhage is another cause of primary adrenal insufficiency. what does this mean?

A

it is the rupture of the adrenal cortex blood vessels d/t increased BP leading to tissue ischemia

24
Q

what type of adrenal insufficiency is metastatic cancer a cause of?

A

primary!

25
Q

what is the cause of secondary adrenal insufficiency disease?

A

hypopituitarism causing a decrease in ACTH
- pituitary tumors and surgery

26
Q

what is the cause of tertiary adrenal insufficiency disease?

A
  1. prolonged high-dose glucocorticoid use suppresses the HPA axis
  2. effects of cushings syndrome tx
27
Q

what does the hypothalamus secrete in the HPA axis?

A

CRH

28
Q

what happens after the hypothalamus secretes CRH in the HPA axis?

A

ACTH is released from the anterior pituitary gland

29
Q

what is the zona glomerulosa primarily regulated by and why?

A

RAA and potassium levels
because the zona glomerulosa secretes aldosterone

30
Q

when does ACTH peak?

A

8:30 am

31
Q

what does ACTH mainly stimulate?

A

the zona fasciculata and zona reticularis

32
Q

what is the clinical presentation of addison’s?

A

> or equal to 90% destruction of adrenal tissue by the time symptoms appear

33
Q

with a decrease in glucocorticoid presentation in addison’s what will you see?

A
  • fatigue
  • weakness
  • weight loss/anorexia
  • myalgia/joint pain
  • abdominal pain/diarrhea
  • hypoglycemia
34
Q

with a decrease in mineralcorticoid presentation in addison’s what will you see?

A
  • hypotension, dizziness
  • hyperkalemia, hyponatremia (salt craving)
    -metabolic acidosis
35
Q

with a decrease in androgen presentation in addison’s what will you see?

A
  • decreased axillary and pubic hair
  • loss of libido
  • amenorrhea in women
36
Q

what is the most characteristic clinical presentation of addison’s?

A

hyperpigmentation from increased ACTH (sun exposed areas)

37
Q

what are the diagnostic tests for addison’s?

A
  1. morning serum cortisol
  2. ACTH levels
  3. high-dose ACTH stimulation test
38
Q

what is a normal serum cortisol level?

A

10-20

39
Q

what cortisol levels strongly suggest Adrenal insufficiency?

A

decrease in serum cortisol (< or equal to 3)

40
Q

what is involved in ACTH level testing?

A

this is to obtain baseline level simultaneouslt with morning cortisol

41
Q

what does increased ACTH levels indicate?

A

primary adrenal insufficiency (issue w/ adrenal gland)

42
Q

what does decreased or normal ACTH suggest?

A

secondary/tertiary adrenal insufficiency

43
Q

what does a high-dose ACTH stimulation test do?

A

measure a baseline serum sorticol and plasma ACTH

44
Q

what is done during a high-dose ACTH stimulation test?

A
  1. administration of 250 mcg of cosynotropin (synthetic ACTH) IV or IM
  2. measure serum cortisol at 30 and 60 minutes
45
Q

what does a decreased cortisol and increased ACTH level on high-dose ACTH stimulation test indicate?

A

primary adrenal insufficiency

46
Q

what does a decreased cortisol and decreased or normal ACTH level on high-dose ACTH stimulation test indicate?

A

secondary adrenal insufficiency

47
Q

what are the treatment options for addisons?

A
  1. glucocorticoid replacement
  2. mineralcorticoid replacement
  3. tx underlying cause
48
Q

what does glucocorticoid treatment for addisons entail?

A
  • use lowest tolerated dose to control sx
    1. oral hydrocortisone in 2-3 divided doses
    • stress dosing
      > used for illnesses and before surgery
      > dose is 3x maintenance dose x3 days
49
Q

what does mineralcorticoid treatment for addisons entail?

A
  1. fludrocortisone
50
Q

what is the MOA of fludrocortisone?

A

it is a mineralcorticoid agonist, but also stimulates glucocorticoid receptors
increases sodium and water resorption
duration of action 8-12 hours
side effects: fluid retention, hypertension, edema, hypokalemia, hyperglycemia

51
Q

what is an adrenal crisis?

A
  • a medical emergency more likely to occur in primary disease than secondary disease
  • usually precipitated by severe stress (infxn, trauma, surgery)
52
Q

what is the clinical presentation of an adrenal crisis?

A
  1. profound weakness
  2. abdominal pain- mimics abdominal emergency
  3. hypotension
  4. orthostasis
  5. shock
  6. fever- when precipitated by infection
53
Q

what is the treatment for an adrenal crisis?

A
  1. IV fluid resuscitation
  2. hydrocortisone phosphate or hydrocortisone sodium 100- 300 mg IV over 30 seconds, then 50 mg every 6 hours
  3. treat electrolyte imbalances and hypoglycemia
  4. search for underlying condition and tx accordingly

ENDOCRINE (18 decks)

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