Adrenal Pathology

Question 1

What three disorders of the adrenal gland cause too much hormones?

Answer 1

Cushing syndrome
Hyperaldosteronism
Adrenogenital syndrome

Question 2

What tests are used to diagnose Cushing Syndrome?

Answer 2

24 hour urine free cortisol
Loss of normal diurnal cortisol secretion
ACTH level
Dexamethasone suppression test

Question 3

What is the most common cause of Cushing syndrome?

Answer 3

Iatrogenic Cushing

Drugs caused

Question 4

What do Cortisol/ACTH tests look like for Iatrogenic Cushing Syndrome?

Answer 4

Increased Cortisol

Decreased ACTH

Question 5

What is the most common endogenous cause of Cushing syndrome?

Answer 5

Cushing Disease

Question 6

What do Cortisol/ACTH levels look like for Cushing Disease?

Answer 6

Cortisol increased

ACTH increased

Question 7

What happens to cortisol levels with a high-dose dexa test in Cushing disease?

Answer 7

Supresses

Question 8

What are causes of adrenal cushing syndrome?

Answer 8

Adenoma, hyperplasia, carcinoma

Question 9

What are Cortisol/ACTH levels for Adrenal Cushing Syndrome?

Answer 9

Increased cortisol

Decreased ACTH

Question 10

What happens to cortisol levels with a high-dose dexa test in Adrenal cushing syndrome?

Answer 10

No suppression

Question 11

What is the most common cause of paraneoplastic cushing syndrome?

Answer 11

SCC of the lung

Question 12

What are Cortisol/ACTH levels for paraneoplastic Cushing syndrome?

Answer 12

Increased cortisol
Increased ACTH (fake)

Question 13

What happens to cortisol levels with a high-dose dexa test in paraneoplastic Cushing syndrome?

Answer 13

No suppression

Question 14

What are the main effects of aldosterone?

Answer 14

Retain Na and H2O

Pee out K

Question 15

What are symptoms of hyperaldosteronism?

Answer 15

Hypertension

Hypokalemia (weakness, fatigue, psychosis)

Question 16

What are common lab findings of primary hyperaldosteronism?

Answer 16

Elevated Aldosterone
Low Renin
Hypernatremia
Hypokalemia
Metabolic alkalosis

Question 17

What are the most common causes of primary hyperaldonism?

Answer 17

Cortical adenoma (Conn Syndrome)
Cortical hyperplasia

Question 18

What are the common causes of secondary hyperaldosteronism?

Answer 18

Anything that increases renin
CHF\
Decreased renal blood flow
Renin producing tumors

Question 19

What are the lab findings of secondary hyperaldosteronism?

Answer 19

Same as primary with HIGH renin

Question 20

If you have a patient with SUDDEN virilization, what is likely the problem?

Answer 20

Adrenocortical carcinoma

Question 21

What does adrenocortical carcinoma look like grossly?

Answer 21

Necrotic, ugly tumor

Question 22

What’s the prognosis like for adrenocortical carcinoma?

Answer 22

Bad.

Question 23

What’s the most common cause of congenital adrenal hyperplasia?

Answer 23

21-hydroxylase deficiency

Question 24

What is the result of 21 hydroxylase deficiency?

Answer 24

Decreased cortisol and aldosterone

Increased sex steroids

Question 25

What is Addison disease?

Answer 25

Primary chronic adrenal insufficiency

Question 26

What is the cause of Addison disease?

Answer 26

Usually autoimmune

Question 27

What are symptoms of Addison disease?

Answer 27

Weakness, fatigue, GI complaints Hypotension Skin hyperpigmentation

Question 28

What are causes of primary acute adrenal insufficiency?

Answer 28

Addisonian crisis Rapid steroid withdrawal Massive adrenal hemorrhage

Question 29

When do you see massive adrenal hemorrhage?

Answer 29

Neisseria infection in an infant

Question 30

What is Waterhouse-Friderichsen syndrome?

Answer 30

The neisseria infection of an infant

Question 31

What does Waterhouse Friderichsen syndrome look like?

Answer 31

Hypotension, shock DIC Massive bilateral adrenal hemorr. Rapidly progressive

Question 32

What are the most common causes of secondary adrenal insufficiency?

Answer 32

Pituitary or hypothalmic insufficiency | Tumor, infection, radiation, infarction

Question 33

What does secondary adrenal insufficiency look like?

Answer 33

Symptoms of decreased cortisol and decreased sex steroids | Mineralocorticoids normal because Renin axis is intact

Question 34

What are the 10%'s of a Pheochromocytoma?

Answer 34

``` 10% extra-adrenal 10% bilateral 10% (or more) familial 10% malignant 10% don't have hypertension ```

Question 35

What is a pheochromocytoma?

Answer 35

Neoplasm of catecholamine producing cells

Question 36

What do you look for in the urine if you suspect pheochromocytoma?

Answer 36

Catecholamines VMA Metanephrines

Question 37

What are symptoms of pheochromocytoma?

Answer 37

``` Pressure (BP inc) Pain (Headache) Perspiration Palpitations (tachy) Pallor Paroxysms ```

Question 38

More copies of this gene cause a worse prognosis in neuroblastoma.

Answer 38

N-myc

Question 39

Who commonly gets neuroblastomas?

Answer 39

children

Question 40

What are often seen on slide examination for neuroblastomas?

Answer 40

Homer-wright rosettes