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Hormonal & Reproductive Week 1 - WLB > Adrenal Pathology - Krafts > Flashcards

Adrenal Pathology - Krafts Flashcards

1
Q

What conditions are caused by too much hormone production in the adrenal glands?

A

Cushing syndrome

Hyperaldosteronism

Adrenogenital syndrome

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2
Q

What are the effects of Cortisol?

A

Cortisol is BBIIG:

Maintains Blood pressure

Breaks down Bone

Suppresses Inflammation

Suppresses Immune system

Stimulates Gluconeogenesis

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3
Q

What are the symptoms of Cushing Syndrome?

A

***Hypertension

***Weight gain

Characteristic habitus

Weakness

Glucose intolerance

Thin skin, osteoporosis

Infection

Mental changes

Hirsutism, menstrual abnormalities

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4
Q

What lab tests are used to Dx Cushing Syndrome?

A

For diagnosis => 24-hour urine free cortisol, Loss of normal diurnal cortisol secretion

For finding cause => ACTH level, Dexamethasone suppression test

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5
Q

What is Iatrogenic Cushing Syndrome?

A 
Been on steroids long-term
Most common cause!
Hypoplastic adrenal cortices
Lab tests:
↑ cortisol (no suppression)
↓ ACTH
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6
Q

What is Pituitary Cushing Syndrome

(Cushing Disease)?

A 
70% of endogenous Cushing
Hyperplastic adrenal cortices
Lab tests:
 cortisol (suppresses*) 
 ACTH 
Dx with * with high-dose dexamethasone
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7
Q

What are the two effects of Aldosterone?

A
  1. Retain Na+ and H2O

2. Pee out K+

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8
Q

Primary Hyperaldosteronism

A 
↑ aldosterone => ↓ renin
Cortical adenoma (Conn syndrome) 
Cortical hyperplasia
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9
Q

Sx of Primary Hyperaldosteronism

A

Symptoms
Hypertension (hypernatremia)
Weakness/fatigue/psychosis (hypokalemia)

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10
Q

Lab tests to Dx Hyperaldosteronism

A

Increased aldosterone
Decreased renin
Hypernatremia
Hypokalemia

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11
Q

Secondary Hyperaldosteronism

A

 renin   aldosterone
 renal blood flow, renin-producing tumor
Symptoms same as primary
Labs same EXCEPT  renin!

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12
Q

Causes of Virilization

A

Primary gonadal disorders
Primary adrenal disorders
adrenocortical neoplasms
congenital adrenal hyperplasia

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13
Q

Adrenocortical Carcinoma

A 
Rare!
  Abdominal mass 
  Clue: sudden virilization 
  Necrotic, “ugly” tumor
  Bad prognosis
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14
Q

What is the most common cause of CAH?

A

21-hydroxylase deficiency

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15
Q

What is the result of 21-hydroxylase deficiency?

A

↓ cortisol

↓ aldosterone (hypotension, hyponatremia)

↑ sex steroids (virilization)

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16
Q

What are the three types (depending on mutation) of 21-hydroxylase deficiency?

A
  1. salt-wasting (no mineralocorticoids)
  2. simple virilizing (some mineralocorticoids)
  3. late-onset virilizing (some mineralocorticoids, some cortisol)
17
Q

What condition causes Primary Chronic Adrenal Insufficiency?

A

Addisons disease

18
Q

What is the cause of Primary Chronic Adrenal Insufficiency?

A

usually autoimmune destruction of adrenal cortex => too little cortisol and mineralocorticoids

19
Q

What are the symptoms of Primary Chronic Adrenal Insufficiency?

A

Weakness, fatigue, GI complaints
***Hypotension
Skin hyperpigmentation

20
Q

What is Primary Acute Adrenal Insufficiency?

A

Adrenals suddenly aren’t releasing their stuff

21
Q

What are the causes of Primary Acute Adrenal Insufficiency?

A

Addisonian crisis

Rapid steroid withdrawal

Massive adrenal hemorrhage (bacterial infection - Niesseria)

22
Q

What causes Waterhouse-Friderichsen Syndrome?

A

Bacterial infection (N. meningitidis)

23
Q

What are the symptoms of Waterhouse-Friderichsen Syndrome?

A

Hypotension, shock
DIC
Massive, bilateral adrenal hemorrhage
Rapidly progressive

24
Q

What are the causes of Secondary Adrenal Insufficiency?

A

Pituitary or hypothalamic insufficiency

Tumor, infection, radiation, infarction

25
Q

What are the features of Secondary Adrenal Insufficiency?

A

Symptoms of ↓ cortisol
Mineralocorticoids normal (renin axis is intact)
No hyperpigmentation

26
Q

What is a Pheochromocytoma?

A

Neoplasm of catecholamine-producing cells

Rare cause of hypertension!

27
Q

Why is a Pheochromocytoma called “The 10% tumor”?

A

10% extra-adrenal (“paraganglioma”)

10% bilateral

10% (or more) familial

10% malignant

10% don’t have hypertension

28
Q

How do you diagnose Pheochromocytoma?

A

Urine: catecholamines, or breakdown products = VMA and metanephrines

29
Q

What are the symptoms of Pheochromocytoma?

A

Paroxysms (spells of Sx)

Pressure (increased blood pressure)

Pain (headache)

Perspiration

Palpitations (tachycardia)

Pallor

30
Q

What is a Neuroblastoma?

A

Derived from neural crest cells

Relatively common childhood tumor

31
Q

What patient circumstances result in a better prognosis of Neuroblastoma?

A

Children

32
Q

How does a Neuroblastoma present?

A

Usually children with abdominal mass that father/mother notices when he/she is changing the diaper

Hormonal & Reproductive Week 1 - WLB (13 decks)

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