Adrenal Pathology - Krafts Flashcards
What conditions are caused by too much hormone production in the adrenal glands?
Cushing syndrome
Hyperaldosteronism
Adrenogenital syndrome
What are the effects of Cortisol?
Cortisol is BBIIG:
Maintains Blood pressure
Breaks down Bone
Suppresses Inflammation
Suppresses Immune system
Stimulates Gluconeogenesis
What are the symptoms of Cushing Syndrome?
***Hypertension
***Weight gain
Characteristic habitus
Weakness
Glucose intolerance
Thin skin, osteoporosis
Infection
Mental changes
Hirsutism, menstrual abnormalities
What lab tests are used to Dx Cushing Syndrome?
For diagnosis => 24-hour urine free cortisol, Loss of normal diurnal cortisol secretion
For finding cause => ACTH level, Dexamethasone suppression test
What is Iatrogenic Cushing Syndrome?
Been on steroids long-term Most common cause! Hypoplastic adrenal cortices Lab tests: ↑ cortisol (no suppression) ↓ ACTH
What is Pituitary Cushing Syndrome
(Cushing Disease)?
70% of endogenous Cushing Hyperplastic adrenal cortices Lab tests: cortisol (suppresses*) ACTH Dx with * with high-dose dexamethasone
What are the two effects of Aldosterone?
- Retain Na+ and H2O
2. Pee out K+
Primary Hyperaldosteronism
↑ aldosterone => ↓ renin Cortical adenoma (Conn syndrome) Cortical hyperplasia
Sx of Primary Hyperaldosteronism
Symptoms
Hypertension (hypernatremia)
Weakness/fatigue/psychosis (hypokalemia)
Lab tests to Dx Hyperaldosteronism
Increased aldosterone
Decreased renin
Hypernatremia
Hypokalemia
Secondary Hyperaldosteronism
renin aldosterone
renal blood flow, renin-producing tumor
Symptoms same as primary
Labs same EXCEPT renin!
Causes of Virilization
Primary gonadal disorders
Primary adrenal disorders
adrenocortical neoplasms
congenital adrenal hyperplasia
Adrenocortical Carcinoma
Rare! Abdominal mass Clue: sudden virilization Necrotic, “ugly” tumor Bad prognosis
What is the most common cause of CAH?
21-hydroxylase deficiency
What is the result of 21-hydroxylase deficiency?
↓ cortisol
↓ aldosterone (hypotension, hyponatremia)
↑ sex steroids (virilization)
What are the three types (depending on mutation) of 21-hydroxylase deficiency?
- salt-wasting (no mineralocorticoids)
- simple virilizing (some mineralocorticoids)
- late-onset virilizing (some mineralocorticoids, some cortisol)
What condition causes Primary Chronic Adrenal Insufficiency?
Addisons disease
What is the cause of Primary Chronic Adrenal Insufficiency?
usually autoimmune destruction of adrenal cortex => too little cortisol and mineralocorticoids
What are the symptoms of Primary Chronic Adrenal Insufficiency?
Weakness, fatigue, GI complaints
***Hypotension
Skin hyperpigmentation
What is Primary Acute Adrenal Insufficiency?
Adrenals suddenly aren’t releasing their stuff
What are the causes of Primary Acute Adrenal Insufficiency?
Addisonian crisis
Rapid steroid withdrawal
Massive adrenal hemorrhage (bacterial infection - Niesseria)
What causes Waterhouse-Friderichsen Syndrome?
Bacterial infection (N. meningitidis)
What are the symptoms of Waterhouse-Friderichsen Syndrome?
Hypotension, shock
DIC
Massive, bilateral adrenal hemorrhage
Rapidly progressive
What are the causes of Secondary Adrenal Insufficiency?
Pituitary or hypothalamic insufficiency
Tumor, infection, radiation, infarction
