Adrenals I

Question 1

zones of adrenal Cx

Answer 1

zona glomerulosa
zona fasciculata
zone reticularis

Question 2

zona glomerulosa makes what

Answer 2

mineralocorticoids- aldosterone

Question 3

zona fasciculata produce what

Answer 3

glucocorticoids- cortisol

Question 4

zone reticularis produce what

Answer 4

sex steroids like estrogens and androgens

Question 5

what does the adrenal medulla make

Answer 5

chromaffin cells which secrete catecholamines like epinephrine

Question 6

3 syndromes of adrenal hyperfunction

Answer 6

cushin syndrome- excess cortisol
hyperaldosteronism- excess aldosterone
adrenogenital or virilizing syndrome- excess androgens

Question 7

central obesity, moon facies

abdomina striae

Answer 7

cushings

Question 8

majority cases of cushins from

Answer 8

administration of exogenous glucocorticoids “iatrogenic”

Question 9

endogenous causes of cushings

Answer 9

ACTH dependent

ACTH independent

Question 10

what are the ACTH dependent causes of cushings

Answer 10

pituitary adenoma-cushing disease

ectopic corticotropin syndrome

Question 11

what are the ACTH independent causes of cushings

Answer 11

adrenal adenoma
adrenal carcinoma
macronodular hyerplasia
primary pigmented nodular adrenal disease
McCune Albright syndrome

Question 12

most common cause of endogenous hypercortisolism

Answer 12

ACTH secreting pituitary adenoma

Question 13

Cushing disease affects men or women more

Answer 13

women

Question 14

secretion of ectopic ACTH leading to Cushing syndrome is from what typ of tymors

Answer 14

many nonpituitary

most being small cell carcinoma in lung

Question 15

most common causes ACTH independent cushing

Answer 15

adrenal adenoma and carcinoma

Question 16

what lab values will you find with ACTH independent cushing syndrome

Answer 16

elevated cortisol and low ACTH

Question 17

what changes will you see morphologically in pituitary in cushings

Answer 17

crooke hyaline change- accumulation of intermediate keratin filaments in the cytoplasm

Question 18

ACTH dependent cushing syndrome will cause what changes in adrenal

Answer 18

nodularity and diffuse hyperplasia

Question 19

adrenocortical adenomas look like what

Answer 19

yellow tumors surrounded by thin capsules

Question 20

what do carcinomas assoc with cushing look like

Answer 20

unencapsulated masses taht are large and have all anaplastic characteristics of cancer

Question 21

early stages of cushing syndrome

Answer 21

HTN and weight gain

Question 22

buffalo hump

Answer 22

cushing

Question 23

hypercortisolism affects muscles how

Answer 23

selective atrophy of fast twitch (type 2) myofibers

resulting in decreased muscle mass and proximal limb weakness

Question 24

how do glucocorticoids cause hyperglycemia, glucosuria and polydipsia

Answer 24

induce gluconeogenesis and inhibit the uptake of glucose by cells

Question 25

how do glucocorticoids cause thin fragile skin that is easily bruised

Answer 25

loss of collagen and resorption of bones

Question 26

what mental disturbances do glucocorticoids cause

Answer 26

mood swings, depression, frank psychosis

Question 27

Dx cushing

Answer 27

24 urine free cortisol concentration is increased
loss of normal diurnal pattern of cortisol secretion
DXM suppression test

Question 28

what is DXM test

Answer 28

give DXM and then measure corticosteroid level
-if ACTH cannot be suppressed by low dose DXM but - at high dose DXM pituitary can respond and reduce ACTH then know is pituitary cushing syndrome

Question 29

if cortisol does not decrease with high or low doses DXM what is it

Answer 29

ectopic ACTH secretion

Question 30

When Cushing is from adrenal tumor what will ACTH level be

Answer 30

low because of feedback inhibition of the pituitary

Question 31

in adrenal tumor cushing what will results of high and low DXM test be

Answer 31

fail to suppress cortisol excretion

Question 32

high ACTH with no suppression after high DXM

Answer 32

CT to rule out ectopic ACTH

Question 33

high ACTH with suppression after high DXM

Answer 33

cushing disease, need MRI

Question 34

bilateral cortical atrophy of adrenals is a feature of what

Answer 34

exogenous steroid induced disease

Question 35

what causes primary hyperaldosteronism

Answer 35

autonomous overproduction of aldosterone with suppression of RAAS and decreased plasma renin

Question 36

most common manifestation primary hyperaldosteronism

Answer 36

bp elevation

Question 37

most common cause primary hyepraldosteronism

Answer 37

b/l idiopathic hyperaldosteronism

Question 38

what is the most common adrenocortical neoplasm

Answer 38

aldosterone producing adenoma

Question 39

conn syndrome

Answer 39

solitary aldosterone secreting adenoma

Question 40

conn syndrome gender distribution

Answer 40

more common W:M 2:1

Question 41

mutaiton in glucocorticoid-remediable hyperaldosteronism

Answer 41

rearrangement on chromosome 8 that places CYP11B2 (encodes aldosterone synthase)

Question 42

what can lead to increased levels of plasma renin

Answer 42

decreased renal perfusion
arterial hypovolemia and edema
pregnancy

Question 43

<2cm solitary mass buried in adrenal gland
bright yellow on cut section with uniform cells
spironolactone bodies

Answer 43

aldosterone producing adenoma

Question 44

what will the contralateral adrenal gland look like if one has aldosterone producing adenoma

Answer 44

not atrophic

Question 45

consequences of hyperaldosteronism

Answer 45

L ventricular hypertrophy and reduced diastolic volumes

increased risk stroke and MI

Question 46

Dx primary hyperaldosteronism

Answer 46

elevated ratios of plasma aldosterone concentration to plasma renin activity
then need an aldosterone suppression test to confrim