ADRENALS

Question 1

what part of the efferent nervous system stimulates the adrenals?

Answer 1

sympathetic neurons from the spinal cord

Question 2

pituitary tumor with excessive ACTH secretion is called?

what other type of neoplasm?

Answer 2

cushing disease (pituitary adenomas in over 90%)
-bilateral adrenocortical hyperplasia, we see hyper secretion of cortisol

nonpituitary neoplasm

Question 3

feedback inhibition of pituitary ACTH by physiologic levels of GCs is suppressed or enhanced?

Answer 3

suppressed, ACTH hyper secretion persists and chronic glucocorticoid excess

Question 4

iatrogenic cushings syndrome form exogenous steroids is most common and is considered independent or dependent cushing syndrome?

Answer 4

independent cushings which is iatrogenic
or
adernocortical adenoma or carcinoma

Question 5

common manifestations of cushings syndrome?

Answer 5

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

Question 6

how is cortisol level demonstrated in the diagnosis of cushing syndrome?

Answer 6

24-hour urinary cortisol
late-night salivary cortisol
dexamethasone suppression test (DST)

Question 7

ACTH<5 pg/ml

adrenal adenoma

or

adrenal carcinoma

ACTH independent or ACTH dependent

Answer 7

ACTH independent, image the abdomen

Question 8

ACTH>20 pg/ml

pituitary corticotroph adenoma or ectopic ACTH or CRH secretion

ACTH-independent or ACTH-dependent?

Answer 8

ACTH dependent, determine if pituitary or ectopic then imaging

Question 9

major tx for cushing disease?

Answer 9

transsphenoidal pituitary microsurgery with adenoma removal

option:

radiation therapy to the pituitary lesion

bilateral adrenalectomy (laparoscopic)

Question 10

name this adrenal insufficiency type?

glucocorticoid deficiency 
adrenal androgen deficiency 
-testosterone
-DHEA
mineralocorticoid deficiency 

primary adrenal or secondary adrenal insufficiency?

Answer 10

primary adrenal insufficiency

Question 11

name this type of secondary adrenal insufficiency?

glucocorticoid deficiency

adrenal androgen deficiency

• testosterone
• DHEA

primary or secondary adrenal insufficiency?

Answer 11

secondary adrenal insufficiency

Question 12

primary adrenal insufficiency, aka?

most common cause in the US?

world?

less common cause?

Answer 12

addison’s disease

autoimmune adrenalitis

TB

infection, hemorrhage, adrenalectomy, metastatic disease: lung or breast CA

Question 13

weakness, fatigue

anorexia, nausea, vomiting, weight loss

hypotension

hypoglycemia

hyponatremia

abdominal pain

amenorrhea

what is this primary adrenal insufficiency?

Answer 13

adrenocortical

Question 14

hyponatremia

hyperkalemia

acidosis

what is this primary adrenal insufficiency?

Answer 14

mineralocorticoid

Question 15

major feature of primary adrenal insufficiency?

Answer 15

hyperpigmentation

Question 16

dysfunction of the HPA axis is what type of adrenal insufficiency?

Answer 16

secondary, treated with exogenous GC therapy or pituitary or hypothalamic tumors

atrophy of ZF and ZR

• decreased cortisol
• decreased androgen

Question 17

main cause of secondary adrenal insufficiency?

Answer 17

oral corticosteroids

inhaled corticosteroids

topical steroids

*both can affect HAP axis

systemic absorption and HPA suppression

intraarticular glucocorticoids

spinal GC injections

Question 18

ACTH stimulation test?

Answer 18

synthetic corticotropin

• meaure baseline serum cortisol
• administer 250 mcg
• measure serum cortisol at 30 minutes

Question 19

if primary adrenal insufficiency with mineral corticoid deficiency, what is the tx?

androgen replacement?

dose of oral hydrocortisone should be _____ if intercurrent illness

Answer 19

fludrocortisone supplementation

DHEA

doubled, IV hydrocortisone will be needed if vomiting, surgery, or trauma

Question 20

a life threatening medical emergency condition caused by insufficient cortisol to meet physiological stress needs

Answer 20

adrenal crisis

Question 21

tx of adrenal crisis?

Answer 21

resuscitation

address the ABCs

address electrolyte abnormalities

provide glucose as needed

provide stress dose IV hydrocortisone, or sometimes fludrocortisone