Adrenal Pathophysiology

Question 1

Cushing’s syndrome is ____ secretion- most common cause is

Answer 1

excess cortisol; iatrogenic

Question 2

Three main issues in Cushing’s syndrome

Answer 2

1. Loss of diurnal cortisol levels
2. Loss of response to feedback inhibition
3. Excess cortisol secretion

Question 3

ACTH dependent Cushing’s syndrome is most commonly

Answer 3

Cushing’s Disease (pituitary adenoma)

Question 4

Ectopic ACTH syndrome is commonly excreted by __ cancer

Answer 4

small cell lung cancer

Question 5

ACTH independent Cushing’s syndrome include __ cancers

Answer 5

adrenal

Question 6

Effect of Cushing’s syndrome on
Carbs
Fat
Protein

Answer 6

Carbs- stimulates gluconeogenesis- hyperglycemia
Fat- lipogenesis/insulin resistance- increased FFA
Protein- catabolic breakdown of proteins to feed GnG

Question 7

Fat under the chin is called

Answer 7

Dewlap

Question 8

Most specific fat finding of cortisol excess

Answer 8

Supraclavicular fat pad

Question 9

Cortisol excess effect on
Immunity
Blood
Eyes
MSK (3) bone, muscle, fat

Answer 9

Impaired immunity
Increased clotting factors
Cataracts
Osteoporosis, redistribution of body fat, proximal myopathy

Question 10

Cortisol effect on skin

Answer 10

thins out skin

Question 11

Cortisol excess makes marks on skin called ___, and area in areas of ___ on the skin

Answer 11

striae, stress

Question 12

__ stimulates all three layers of the adrenal cortex

Answer 12

ACTH

Question 13

Cortisol excess also stimulates ___ (hormone) resulting in acne, body hair

Answer 13

androgens

Question 14

Too much cortisol can start acting like ___, and cause ___ and ___ (kidney)

Answer 14

mineralocorticoid, hypertension, hypokalemia

Question 15

Marked virilization of a women is more worrisome for___

Answer 15

malignant adrenal tumor

Question 16

Exogenous ___ substitutes for endogenous cortisol in suppression of __

Answer 16

dexamethasone; ACTH

Question 17

___ tumors have appropriate levels of ACTH

Answer 17

adrenal

Question 18

Addison’s disease is

Answer 18

primary adrenal failure

Question 19

Symptoms of primary adrenal failure

Answer 19

hypotension, low salt (hyponatremia) high K (hyperkalemia)

Question 20

Elevated ACTH in Addison’s causes

Answer 20

hyperpigmentation

Question 21

Most common cause of Addison’s

Answer 21

autommine infection

Question 22

The provocative ___ gives __ to test adrenal response

Answer 22

cosyntropin synthetic testing; synthetic ACTH

Question 23

Short term treatment of Addison is

Answer 23

dexamethasone

Question 24

Need both _ and _ deficiencies for adrenal crisis

Answer 24

cortisol; mineralocorticoids

Question 25

Mineralocorticoid excess findings 2 main, 1 random

Answer 25

Hypertension, hypokalemia, metabolic alkalosis

Question 26

Two causes of hyperaldosteronism

Answer 26

Adrenal adenoma, Bilateral adrenal hyperplasia

Question 27

A high morning ___ ratio is used to screen for hyperaldosternism

Answer 27

aldosterone to renin