Adrenal Pathology Flashcards
Cushing syndrome
excess steroid production
ie elevated free serum cortisol
Dx of Cushing syndrome
24 hr free urine cortisol
b/c pulsatile in nature, higher in the morning
When can you use a dexamethaxone suppression test
in Cushing disease
ie pituitary tumor secreting ACTH
Iatrogenic Cushings labs
cortisol
ACTH
high cortisol
low ACTH
What happens when you don’t taper steroids?
iatrogenic Addison’s disease
- adrenal medulla begins to atrophy
- need to taper so it can grow more and become more functional before quitting steroids
Pituitary Cushings labs
cortisol
ACTH
high cortisol
high ACTH
*responds to dexamethaxone suppression test
Adrenal Cushings labs
cortisol
ACTH
high cortisol
low ACTH
*b/c feedback inhibition is working
Paraneoplastic Cushings labs
cortisol
ACTH
high cortisol
high “fake” ACTH, ie ACHTrp
Function of aldosterone
retain salt and water
excrete K+
2˚hyperaldosteronism
renin and aldosterone levels
high renin
high aldosterone
*due to decreased renal blood flow, renin-producing tumor
Adrenocortical tumor
manifestation
prognosis
sudden viralization
necrotic, ugly tumor as abdominal mass
Congenital adrenal hyperplasia
basics
21-hydroxylase deficiency is more common
basically can’t make mineral and/or glucocorticoids, so shunted to sex hormones
3 forms: servere, moderate, late-onset
Addison’s disease
basics
1˚ chornic adrenal insufficiency
- hypotension
- skin hyperpigmentation
- weakness, fatigue, GI complaints
1˚ acute adrenal insufficiency
etiologies
Addisonian crisis
rapid steroid withdrawl (adrenals atrophy–need to taper)
massive adrenal hemorrhage
Waterhouse-Friedrichsen Syndrome
etiology
complications
N. meningitidis infection
DIC –> massive adrenal hemorrhage
==> Addisonian crisis
