Adrenal Pathology Flashcards
What are the adrenocortical hyperfunctioning diseases?
Hypercortisolism (Cushing) Hyperaldosteronism Adrenogenital syndromes (Virilization)
What are the adrenocortical hypofunctioning disease?
Primary acute adrenocortical insufficiency
Primary chronic adrenocortical insufficiency
Secondary adrenocortical insufficiency
What are the two types of hypercortisolism?
Exogenous
Endogenous
Two types of endogenous hypercortisolism?
ACTH-dependent
ACTH-independent
What is hypercortisolism also know as?
Cushing syndrome
What occurs to the adrenal gland in exogenous Cushing syndrome and why?
Adrenocortical atrophy
The exogenous glucocorticoids are inhibiting ACTH release and therefore the adrenal cortex is not creating glucocorticoids and wastes away
What is endogenous ACTH-dependent Cushing syndrome?
ACTH driven cortisol production
What are potential causes of ACTH-dependent Cushing syndrome?
Pituitary adenoma Ectopic ACTH (small cell lung carcinoma)
What is a pituitary adenoma causing hypercortisolism called?
Cushing disease
What causes ACTH-independent hypercortisolism?
Autonomous cortisol production
Adrenocortical neoplasms
What occurs to the size of the adrenal glands in ACTH-independent hypercortisolism?
Contralateral adrenal gland atrophy due to the affected adrenal gland creating cortisol which then inhibits ACTH release
Do adenomas or carcinomas of the adrenal gland cause more cortisol production?
Carcinomas
What occurs to the diurnal pattern of serum cortisol in Cushing syndrome?
Loss of the diurnal pattern
What is seen in the urine of Cushing syndrome patients?
Urinary excretion of 17-hydroxycorticosteroids
What does dexamethasone (DXM) do?
Inhibits release of ACTH from pituitary
What are the expected values of ACTH when low and high does of DXM are administered to a Cushing disease patient?
Low: no change
High: decrease ACTH release
What occurs in primary hyperaldosteronism?
Autonomous overproduction of aldosterone
What is the status of renin in hyperaldosteronism?
Decreased plasma renin levels
Three causes of primary hyperaldosteronism:
- ) Bilateral idiopathic hyperaldosteronism
- ) Aldosterone-producing adenoma
- ) Glucocorticoid-remediable hyperaldosteronism
What is Conn syndrome?
Aldosterone producing adenoma
What causes glucocorticoid-remediable hyperaldosteronism?
Familial genetics that causes aldosterone synthase to be responsive to ACTH when it typically is not; this means that ACTH will cause an increase in aldosterone and aldosterone does not feedback to inhibit ACTH
How is glucocorticoid-remediable hyperaldosteronism treated?
Glucocorticoids
DXM
Both will inhibit release of ACTH from pituitary gland
Two primary causes of excess adrenal androgens:
- ) Adrenocortical neoplasms
2. ) Congenital adrenal hyperplasia
Why does mixed syndrome occur with adrenocortical neoplasms?
Because they are often caused by adenomas which are grow into the basement membrane into other zones of the adrenal gland and cause hypercortisolism
What is seen with adrenocortical neoplasms?
Decreased ACTH and hypercortisolism
Most common cause of congenital adrenal hyperplasia?
21-hydroxylase deficiency
What is seen in CAH?
Increased ACTH
Increased androgens
Decreased glucocorticoids
What is primary chronic adrenocortical insufficiency known as?
Addison disease
What causes primary acute adrenocortical insufficiency?
Rapid withdrawal of exogenous steroids
Massive bilateral adrenal hemorrhage
What is a disseminated bacterial infection to the adrenal glands known as?
Waterhouse-Friderichsen syndrome
What bacteria typically cause Waterhouse-Friderichsen syndrome?
Neisseria mengitides
What can cause primary chronic adrenocortical insufficiency?
Autoimmune adrenalitis
Tuberculosis
AIDS: CMV
Metastatic cancers
What does POMC stand for?
Pro-opiomelanocortin
What is POMC?
A precursor that is cleaved into ACTH and MSH
What does MSH cause?
Increase in pigmentation
What is the relationship between potassium and sodium in the kidneys?
They are found in inverse relations since they are both cationic if sodium is secreted then potassium is absorbed
Why does skin hyperpigmentation not occur in secondary adrenocortical insufficiency?
Because ACTH is not secreted therefore MSH is not either
