Adrenal Pathology Singh Flashcards
What are the three layers to the adrenal glands and what is secreted?
- Capsule
- Zona Glomerulosa → Aldosterone
- Zona Fasciculata → Cortisol
- Zona Reticularis → Androgens
- Medulla
- GFR → salty, sweet, sex
What happens to the adrenal glands with ACTH dependent cushing syndrome?
Adrenal reactive hyperplasia
Primary Hyperaldosteronism (Conn’s syndrome) symptoms
- Htn
- Hypokalemia
- Hypomagnesemia
Most common cause of hyperaldosteronism?
Idiopathic
SEcondary hyperaldosteronism?
- Diuretics
- decreased renal perfusion
- arterial hypovolemia
- pregnancy
- renin secreting tumors
What is congenital adrenal hyperplasia?
- Inherited error of metabolism (auto recessive)
- Impaired feedback to hypothalamus/pituitary with resultant hyperplasia
- 90-95% of cases caused by 21-hydroxylase deficiency
What is the most significant form of CAH?
- Salt wasting syndrome when you have a complete lack of the enzyme so there are no mineralocorticoids or cortisol
- can diagnose in females at birth due to viriliztion
What happens with a partial lack of enzyme 21 hydroxylase
- some mineralocorticoids and cortisol but not enough to prevent over production of ACTH
- Virilization can occur
Nonclassiv late onset adrenal virilism?
- most common
- partial lack of 21-hydroxylase
- leading to percocious puberty and excess acne and hirsutism at time of puberty
How do we treat 21-hydroxylase deficiency?
- Glucocorticoid administration → provides the negative feedback for ACTH suppression
- mineralocorticoids as needed
Adrenocortical insufficiency primary and secondary cauess?
Primary:
- loss of cortical cells
- defect in hormonoogenesis
Secondary:
- hypothalamic pituitary dissease
- HPA suppression by extra adrenal steroid source
What happens to the adrenal glands when you are on steroids?
- on corticosteroid therapy the adrenals are atrophied, that is why you need to taper steroids to give them a chance to “wake up”
What can cause adrenal hemorrhage?
- Sepsis → waterhouse friderichsen syndrome
- neonatal period
- trauma
- post surgical patients
- coagulopathy
What are the sx of acute adrenal insufficiency
- hypotension → refractory to volume repletion
- abdominal pain
- fever
- n/v
- hyperkalemia
- hyponatremia
- hypoglycemia
Primary chronic adrenocortical insufficiency?
- Long duration of malaise fatigue anorexia and weight loss
- joint pain
- hyperpigmentation of the skin
Primary adrenocortical insufficiency other name and causes?
- Addison’s disease
- 1800’s used to be caused by TB
- Most common cause in developed countries and world wide is autoimmune
Autoimmune Polyendocrine syndrome type 1?
- AIRE gene mutation
- adfrenalitis
- parathyroiditis
- hypogonadism
- pernicioius anemia
- mucocutaneous candidiasis
- ectodermal dystrophy
APECED
What is autoimmune polyendocrine syndrome type 2?
- adrenalitis
- thyroiditis
- DM type 1
Compare size in adrenal cortical adenoma and carcinoma?
Carcinomas are larger than adenoma and weigh more than 200 grams
Presentation of adrenal cortical adenoma?
Incidental finding on radiograph, they’re usually functional
Presentation of adrenal cortical carcinomas?
Indicental finding on radiograph, functional, and compresses/invades adjacent structures. Also causes virilization
what is this
Left is adenoma and right is adrenal carcinoma with large cells and mitotic figures
What cell makes up the adrenal medulla and its function?
Chromaffin cells from the neural crest which are responsible for catecholamine secretion
