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Block 4 - Endocrine > Clin Lab - Adrenal Diagnostics > Flashcards

Clin Lab - Adrenal Diagnostics Flashcards

1
Q

What does HPA axis stand for?

A

Hypothalamic/Pituitary/Adrenal Axis

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2
Q

Major Hormones of the HPA Axis

A
  • Corticotropin Releasing Hormone (CRH)
  • Adrenocorticotropic Hormone (ACTH)
  • Adrenal Cortex Hormones
    –> Cortisol
    –> Aldosterone
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3
Q

3 main types of cortex hormones

A
  1. Glucocorticoids
  2. Mineralocorticoids
  3. Androgens
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4
Q

Glucocorticoids function & example

A

Stress response
Ex - Cortisol

anti-inflammatory, gluconeogenesis, decr bone formation

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5
Q

Mineralocorticoids function & example

A

Water/salt balance, BP
Ex - Aldosterone

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6
Q

Androgens function

A

secondary sex characteristics

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7
Q

Adrenal Medulla hormones

A

epi/norepi
- fight or flight

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8
Q

Causes of Primary disorder:

A
  • Adrenal tumor
  • Autoimmune
  • Genetic/Congenital
  • Damage – trauma, surg, radiation
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9
Q

Causes of 2ndary disorder:

A
  • Pituitary adenoma
  • ACTH-producing tumor
  • Pituitary damage – stroke, radiation, ischemia
  • Genetic
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10
Q

Causes of Tertiary (hypothalamus) disorder:

A
  • Hypothalamus damage – stroke, radiation
  • Tumor
  • Genetic
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11
Q

Other causes for adrenal cortex issues

A

exogenous steroids

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12
Q

Exogenous causes

A

corticosteroids

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13
Q

S/Sx of exogenous hypercortisolism - Cushing syndrome

A

high BP & sugar levels

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14
Q

3 causes of endogenous hypercortisolism - Cushing syndrome

A

primary, secondary, & tertiary hypercortisolism

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15
Q

Describe of primary hyperaldosteronism & cause

A
  • excess production of cortisol from adrenal gland
  • adrenal tumor
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16
Q

Describe of secondary hyperaldosteronism & cause

A
  • excess release of ACTH causes incr cortisol release
  • pituitary adenoma aka Cushing Dz
    OR
  • ectopic tumor via small cell lung CA
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17
Q

Describe of tertiary hyperaldosteronism & cause

A

excess release of corticotropin releasing hormone from hypothalamus
- Stress > PCOS, diabetes

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18
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21
Q

Low dose Dexamethasone Suppression Test

A
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33
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34
Q

Hypocortisolism diagnostics

A
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35
Q

Describe the cosyntropin stimulation test procedure

A
  • Synthetic ACTH (cosyntropin) administered IV
  • Serum cortisol levels drawn at time of injection, 30 min after & 1 hr after injection
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36
Q
A
  • insufficient elevation of cortisol levels = primary adrenal insufficiency
  • sufficient incr in cortisol after injection = secondary /tertiary hypocortisolism
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37
Q

When is serum ACTH done?

A

in AM

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65
Q

Secondary/tertiary causes of hypocortisolism disrupts…

A

both glucocorticoid & mineralocorticoid hormones

66
Q

Findings w/primary causes of hypocortisolism

A
  • Hypoglycemia
  • Hyperkalemia
  • Hyponatremia
  • Elevated BUN
  • Hypercalcemia
  • NAGMA (low CO2, normal anion gap)

Normal serum CO2 22-26

67
Q

Secondary/tertiary causes of hypocortisolism disrupts …

A

only glucocorticoid hormones

68
Q

Findings w/secondary & tertiary causes of hypocortisolism

A

hypoglycemia
- don’t see electrolyte abnormalities like w/primary adrenal insufficiency

69
Q

Initial diagnostic testing to prove cortisol level is low.

A

Early am serum or salivary total cortisol
- In early am, cortisol level should be highest
- AM cortisol < 3 = low

70
Q

Hypothyroidism FU testing Primary vs other causes: if primary causes..

A
  • ACTH will be high
  • Adrenal glands will NOT response to synthetic ACTH
71
Q

Hypothyroidism FU testing Primary vs other causes: if NOT primary causes..

A
  • ACTH will be low
  • Adrenal glands WILL respond to synthetic ACTH
72
Q

What are the FU test used to determine primary vs secondary causes of hypocortisolism?

A
  1. Cosyntropin (synthetic ACTH) stimulation test
  2. Serum ACTH level
73
Q

Describe Cosyntropin stimulation test procedure

A
  • Synthetic ACTH (Cosyntropin) administered IV
  • Serum cortisol levels drawn at time of injection, 30 min after & 1 hr after injection
74
Q

Interpretation of Cosyntropin stimulation test

A
  • insufficient elevation of cortisol levels = primary adrenal insufficiency
  • sufficient increase in cortisol after injection = secondary /tertiary hypocortisolism
75
Q

When should a serum ACTH be done?

A

in AM

76
Q

Interpretation of serum ACTH

A
  • Elevated = primary adrenal insufficiency is likely
  • Low = secondary/tertiary adrenal insufficiency is likely
77
Q

FU diagnostics for hypocortisolism

A

Used to determine cause
- If primary – image the adrenal glands & test mineralocorticoids - CT
- If secondary – image the pituitary – MRI, CT if we can’t

78
Q

Draw out chart for hypocortisolism Labs

A

DONE

79
Q

Describe Congenital adrenal hyperplasia

A
  • inborn metabolic disorders in adrenal hormone biosynthesis
  • most common is deficiency in 21-hydroxylase enzyme
  • leads to hyperplasia of the adrenal glands
  • hypocortisolism leads to increase ACTH
80
Q

Who is screened for congenital adrenal hyperplasia?

A

newborns

81
Q

Congenital Adrenal Hyperplasia pathophys

A

most cases are caused by lack of 21-hydroxylase

82
Q

What is tested in congenital adrenal hyperplasia?

A

17-hydroxyprogestesterone levels

83
Q

Actions of aldosterone

A
  • acts on nephrons
  • increases Na+ reabsorption
    –> more K+ excreted
    –> raises blood volume & therefore BP
84
Q

Hyperaldosteronism is usually what type of issue? Causes?

A
  • usually a primary issue
  • adrenal tumor/hyperplasia
85
Q

Hyperaldosteronism S/Sx

A

HTN

86
Q

Hyperaldosteronism lab findings

A
  • Hypokalemia
  • Hypernatremia
    +/- hyperglycemia
87
Q

Hyperaldosteronism Diagnostics

A

Measure serum renin & serum aldosterone level
- morning blood sample; pt seated for 10-15 min
- renin - can measure level or can measure activity

88
Q

Primary hyperaldosteronism expected levels

A
  • high aldosterone
  • low renin activity
89
Q

Hypoaldosteronism is usually what type of issue? Causes?

A
  • usually not an adrenal issue
  • usually decr renin leads to decr aldosterone
  • kidney dz
  • Meds - ACEI/ARBs/DRI,NSAIDS, Heparin
90
Q

If it is an adrenal issue = Primary adrenal insufficiency: cause & testing

A
  • autoimmune
  • testing: AM cortisol levels, ACTH levels, then cosyntropin test
91
Q

Testing for hypoaldosteronism

A

serum aldosterone & renin activity
- incr renin & decr aldosterone

92
Q

Follow up testing for hypoaldosteronism

A
  • anti 21-hydroxylase antibodies (autoimmune cause)
  • imaging of adrenal glands - CT

Block 4 - Endocrine (5 decks)

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