Adrenal Pathophysiology Flashcards
Cushing’s syndrome is ____ secretion- most common cause is
excess cortisol; iatrogenic
Three main issues in Cushing’s syndrome
- Loss of diurnal cortisol levels
- Loss of response to feedback inhibition
- Excess cortisol secretion
ACTH dependent Cushing’s syndrome is most commonly
Cushing’s Disease (pituitary adenoma)
Ectopic ACTH syndrome is commonly excreted by __ cancer
small cell lung cancer
ACTH independent Cushing’s syndrome include __ cancers
adrenal
Effect of Cushing’s syndrome on
Carbs
Fat
Protein
Carbs- stimulates gluconeogenesis- hyperglycemia
Fat- lipogenesis/insulin resistance- increased FFA
Protein- catabolic breakdown of proteins to feed GnG
Fat under the chin is called
Dewlap
Most specific fat finding of cortisol excess
Supraclavicular fat pad
Cortisol excess effect on Immunity Blood Eyes MSK (3) bone, muscle, fat
Impaired immunity
Increased clotting factors
Cataracts
Osteoporosis, redistribution of body fat, proximal myopathy
Cortisol effect on skin
thins out skin
Cortisol excess makes marks on skin called ___, and area in areas of ___ on the skin
striae, stress
__ stimulates all three layers of the adrenal cortex
ACTH
Cortisol excess also stimulates ___ (hormone) resulting in acne, body hair
androgens
Too much cortisol can start acting like ___, and cause ___ and ___ (kidney)
mineralocorticoid, hypertension, hypokalemia
Marked virilization of a women is more worrisome for___
malignant adrenal tumor
Exogenous ___ substitutes for endogenous cortisol in suppression of __
dexamethasone; ACTH
___ tumors have appropriate levels of ACTH
adrenal
Addison’s disease is
primary adrenal failure
Symptoms of primary adrenal failure
hypotension, low salt (hyponatremia) high K (hyperkalemia)
Elevated ACTH in Addison’s causes
hyperpigmentation
Most common cause of Addison’s
autommine infection
The provocative ___ gives __ to test adrenal response
cosyntropin synthetic testing; synthetic ACTH
Short term treatment of Addison is
dexamethasone
Need both _ and _ deficiencies for adrenal crisis
cortisol; mineralocorticoids
Mineralocorticoid excess findings 2 main, 1 random
Hypertension, hypokalemia, metabolic alkalosis
Two causes of hyperaldosteronism
Adrenal adenoma, Bilateral adrenal hyperplasia
A high morning ___ ratio is used to screen for hyperaldosternism
aldosterone to renin
