ADRENALS Flashcards
what part of the efferent nervous system stimulates the adrenals?
sympathetic neurons from the spinal cord
pituitary tumor with excessive ACTH secretion is called?
what other type of neoplasm?
cushing disease (pituitary adenomas in over 90%) -bilateral adrenocortical hyperplasia, we see hyper secretion of cortisol
nonpituitary neoplasm
feedback inhibition of pituitary ACTH by physiologic levels of GCs is suppressed or enhanced?
suppressed, ACTH hyper secretion persists and chronic glucocorticoid excess
iatrogenic cushings syndrome form exogenous steroids is most common and is considered independent or dependent cushing syndrome?
independent cushings which is iatrogenic
or
adernocortical adenoma or carcinoma
common manifestations of cushings syndrome?
fat deposits on face neck trunk abdomen
sparing of extremities
moon facies with facial plethora
females: increase in adrenal androgens
- hirsutism, acne, amenorrhea
males: cortisol suppression of LH secretion, decreased testosterone
- decreased libido,impotence
skin: thinning of skin, red, purple, striae
metabolic
-glucose intolerance
hemodynamic
-HTN with high DBP
CNS
-emotional stability
MSK
-muscle weakness, osteoporosis
how is cortisol level demonstrated in the diagnosis of cushing syndrome?
24-hour urinary cortisol
late-night salivary cortisol
dexamethasone suppression test (DST)
ACTH<5 pg/ml
adrenal adenoma
or
adrenal carcinoma
ACTH independent or ACTH dependent
ACTH independent, image the abdomen
ACTH>20 pg/ml
pituitary corticotroph adenoma or ectopic ACTH or CRH secretion
ACTH-independent or ACTH-dependent?
ACTH dependent, determine if pituitary or ectopic then imaging
major tx for cushing disease?
transsphenoidal pituitary microsurgery with adenoma removal
option:
radiation therapy to the pituitary lesion
bilateral adrenalectomy (laparoscopic)
name this adrenal insufficiency type?
glucocorticoid deficiency adrenal androgen deficiency -testosterone -DHEA mineralocorticoid deficiency
primary adrenal or secondary adrenal insufficiency?
primary adrenal insufficiency
name this type of secondary adrenal insufficiency?
glucocorticoid deficiency
adrenal androgen deficiency
- testosterone
- DHEA
primary or secondary adrenal insufficiency?
secondary adrenal insufficiency
primary adrenal insufficiency, aka?
most common cause in the US?
world?
less common cause?
addison’s disease
autoimmune adrenalitis
TB
infection, hemorrhage, adrenalectomy, metastatic disease: lung or breast CA
weakness, fatigue
anorexia, nausea, vomiting, weight loss
hypotension
hypoglycemia
hyponatremia
abdominal pain
amenorrhea
what is this primary adrenal insufficiency?
adrenocortical
hyponatremia
hyperkalemia
acidosis
what is this primary adrenal insufficiency?
mineralocorticoid
major feature of primary adrenal insufficiency?
hyperpigmentation
dysfunction of the HPA axis is what type of adrenal insufficiency?
secondary, treated with exogenous GC therapy or pituitary or hypothalamic tumors
atrophy of ZF and ZR
- decreased cortisol
- decreased androgen
main cause of secondary adrenal insufficiency?
oral corticosteroids
inhaled corticosteroids
topical steroids
*both can affect HAP axis
systemic absorption and HPA suppression
intraarticular glucocorticoids
spinal GC injections
ACTH stimulation test?
synthetic corticotropin
- meaure baseline serum cortisol
- administer 250 mcg
- measure serum cortisol at 30 minutes
if primary adrenal insufficiency with mineral corticoid deficiency, what is the tx?
androgen replacement?
dose of oral hydrocortisone should be _____ if intercurrent illness
fludrocortisone supplementation
DHEA
doubled, IV hydrocortisone will be needed if vomiting, surgery, or trauma
a life threatening medical emergency condition caused by insufficient cortisol to meet physiological stress needs
adrenal crisis
tx of adrenal crisis?
resuscitation
address the ABCs
address electrolyte abnormalities
provide glucose as needed
provide stress dose IV hydrocortisone, or sometimes fludrocortisone
