Adrenocortical Insufficiency and adrenocortical neoplasms

Question 1

What is the difference between primary and secondary adrenocortical insufficiency?

Answer 1

Primary adrenal disease, something wrong with the adrenal gland itself.
Decreased stimulation of the adrenals due to a deficiency of ACTH

Question 2

2 main causes of primary adrenocortical insufficiency?

Answer 2

Loss of cortical cells

Defect in hormone production.

Question 3

What are 3 causes of acute adrenal insufficiency?

Answer 3

1. Someone has chronic and there is an episode that needs immediate steroid response and nothing happens.
2. Patient is on exogenous administration and rapid withdrawal.
3. Massive adrenal hemorrhage which damages the adrenal gland

Question 4

What’s going on with Waterhouse friderichsen Syndrome?

Answer 4

Sepsis leads to shock leading to DIC leading to massive hemorrhaging into the adrenal glands.

Question 5

What is the most common pathogen causing Waterhouse systemic shock and what patient population is most commonly affected?

Answer 5

N meningitis.

Children.

Question 6

6 signs to recognize acute adrenal insufficiency?

Answer 6

Hypotension
Ab pain
Fever
N/V
Hyponatremia
Hypoglycemia

Question 7

4 clinical symptoms patients have from primary chronic adrenocortical insuffiency?

Answer 7

Tired
Anoreix and weight loss
Joint pain
Hyperpigmentation of the skin

Question 8

What are the 4 most common causes of primary chronic adrenocortical insuffiency? Which one is most common?

Answer 8

Autoimmune adrenalitis (most common), TB, AIDS, metastatic cancers

Question 9

What is the underlying problem with autoimmune polyendocrine syndrome type 1?

Answer 9

Mutation in AIRE gene resulting in autoantibodies against IL 17 and 22. This is a problem because these are crucial in defense again fungal infections so these people get chronic infections of candidiasis resulting in ectodermal dystrophy.

Question 10

What is the combo or disorders in APS1?

Answer 10

Adrenalitis, parathyroditis, hypogonadism, and pernicious anemia.

Question 11

What are the 3 disorders making up APS2?

Answer 11

Adrenalitis, thyroiditis, and type 1 diabetes.

Question 12

What are the two cancers that cause metastatic adrenal insufficiency?

Answer 12

Breast and lung

Question 13

1 histo feature of autoimmune adrenalitis, TB adrenalitis, and metastasis carcinoma caused insufficiency?

Answer 13

Shrunken and infiltrated
Granulomatous
Enlarged now you have a neoplasm

Question 14

Talk about the prevalence of adrenal adenomas and carcinomas in adults and kids?

Answer 14

About equal prevalence in kids and adults

Carcinomas more common in kids

Question 15

Functional adenomas are associated with what two conditions?

Answer 15

Hyperaldosteronism and Cushing syndrome

Question 16

Functional carcinomas are more associated with what condition?

Answer 16

Virilizing

Question 17

What is the caveat about functional adenomas and carcinomas?

Answer 17

Cannot distinguish morphologically

Question 18

Even though functional adenomas are associated with hyperaldosteronism and cushings, most are clinically what?

Answer 18

Clinically silent and incidentally found on imaging because of some other problem.

Question 19

What color are adrenocortical adenomas usually?

Answer 19

Yellow

Question 20

If we look at an adrenocortical carcinoma, what does it look like?

Answer 20

Necrosis, hemorrhage and cystic change