Adrenal Pathology

Question 1

What are the adrenocortical hyperfunctioning diseases?

Answer 1

Hypercortisolism (Cushing)
Hyperaldosteronism
Adrenogenital syndromes (Virilization)

Question 2

What are the adrenocortical hypofunctioning disease?

Answer 2

Primary acute adrenocortical insufficiency
Primary chronic adrenocortical insufficiency
Secondary adrenocortical insufficiency

Question 3

What are the two types of hypercortisolism?

Answer 3

Exogenous

Endogenous

Question 4

Two types of endogenous hypercortisolism?

Answer 4

ACTH-dependent

ACTH-independent

Question 5

What is hypercortisolism also know as?

Answer 5

Cushing syndrome

Question 6

What occurs to the adrenal gland in exogenous Cushing syndrome and why?

Answer 6

Adrenocortical atrophy
The exogenous glucocorticoids are inhibiting ACTH release and therefore the adrenal cortex is not creating glucocorticoids and wastes away

Question 7

What is endogenous ACTH-dependent Cushing syndrome?

Answer 7

ACTH driven cortisol production

Question 8

What are potential causes of ACTH-dependent Cushing syndrome?

Answer 8

Pituitary adenoma
Ectopic ACTH (small cell lung carcinoma)

Question 9

What is a pituitary adenoma causing hypercortisolism called?

Answer 9

Cushing disease

Question 10

What causes ACTH-independent hypercortisolism?

Answer 10

Autonomous cortisol production

Adrenocortical neoplasms

Question 11

What occurs to the size of the adrenal glands in ACTH-independent hypercortisolism?

Answer 11

Contralateral adrenal gland atrophy due to the affected adrenal gland creating cortisol which then inhibits ACTH release

Question 12

Do adenomas or carcinomas of the adrenal gland cause more cortisol production?

Answer 12

Carcinomas

Question 13

What occurs to the diurnal pattern of serum cortisol in Cushing syndrome?

Answer 13

Loss of the diurnal pattern

Question 14

What is seen in the urine of Cushing syndrome patients?

Answer 14

Urinary excretion of 17-hydroxycorticosteroids

Question 15

What does dexamethasone (DXM) do?

Answer 15

Inhibits release of ACTH from pituitary

Question 16

What are the expected values of ACTH when low and high does of DXM are administered to a Cushing disease patient?

Answer 16

Low: no change
High: decrease ACTH release

Question 17

What occurs in primary hyperaldosteronism?

Answer 17

Autonomous overproduction of aldosterone

Question 18

What is the status of renin in hyperaldosteronism?

Answer 18

Decreased plasma renin levels

Question 19

Three causes of primary hyperaldosteronism:

Answer 19

1. ) Bilateral idiopathic hyperaldosteronism
2. ) Aldosterone-producing adenoma
3. ) Glucocorticoid-remediable hyperaldosteronism

Question 20

What is Conn syndrome?

Answer 20

Aldosterone producing adenoma

Question 21

What causes glucocorticoid-remediable hyperaldosteronism?

Answer 21

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

Question 22

How is glucocorticoid-remediable hyperaldosteronism treated?

Answer 22

Glucocorticoids
DXM
Both will inhibit release of ACTH from pituitary gland

Question 23

Two primary causes of excess adrenal androgens:

Answer 23

1. ) Adrenocortical neoplasms

2. ) Congenital adrenal hyperplasia

Question 24

Why does mixed syndrome occur with adrenocortical neoplasms?

Answer 24

Because they are often caused by adenomas which are grow into the basement membrane into other zones of the adrenal gland and cause hypercortisolism

Question 25

What is seen with adrenocortical neoplasms?

Answer 25

Decreased ACTH and hypercortisolism

Question 26

Most common cause of congenital adrenal hyperplasia?

Answer 26

21-hydroxylase deficiency

Question 27

What is seen in CAH?

Answer 27

Increased ACTH Increased androgens Decreased glucocorticoids

Question 28

What is primary chronic adrenocortical insufficiency known as?

Answer 28

Addison disease

Question 29

What causes primary acute adrenocortical insufficiency?

Answer 29

Rapid withdrawal of exogenous steroids | Massive bilateral adrenal hemorrhage

Question 30

What is a disseminated bacterial infection to the adrenal glands known as?

Answer 30

Waterhouse-Friderichsen syndrome

Question 31

What bacteria typically cause Waterhouse-Friderichsen syndrome?

Answer 31

Neisseria mengitides

Question 32

What can cause primary chronic adrenocortical insufficiency?

Answer 32

Autoimmune adrenalitis Tuberculosis AIDS: CMV Metastatic cancers

Question 33

What does POMC stand for?

Answer 33

Pro-opiomelanocortin

Question 34

What is POMC?

Answer 34

A precursor that is cleaved into ACTH and MSH

Question 35

What does MSH cause?

Answer 35

Increase in pigmentation

Question 36

What is the relationship between potassium and sodium in the kidneys?

Answer 36

They are found in inverse relations since they are both cationic if sodium is secreted then potassium is absorbed

Question 37

Why does skin hyperpigmentation not occur in secondary adrenocortical insufficiency?

Answer 37

Because ACTH is not secreted therefore MSH is not either