Diagnosis of Adrenal Disease Flashcards
the adrenal cortex is responsible for steroid hormone synthesis of […..]. Common pathologies are [….] disease.
mineralocorticoids and gluococorticoids.
Addison’s disease (hypo) and Cushing’s disease (hyper)
the adrenal medulla is responsible for catecholamine synthesis of [……]. Common pathology is [….].
adrenaline and noradrenaline
pheocromocytoma (hyperactive)
cortisol (hydrocortisone) is metabolized into [….]
cortisone acetate (a very weak glucocorticoid)
glucocorticoids act on the liver to simulate [….], on the muscles to […..], on adipose tissue to stimulate […], and to […activate/suppress..] the immune system.
gluconeogenesis
mobilize amino acids
lipolysis
suppress
too much cortisol can lead to weight […], […] of muscle, skin, and bone, [..]glycaemia, […]tension, and [….] of linear growth.
gain, wasting, hyperglycaemia hypertension reduction/inhibition
the main causes of acth-dependant hypercortisolism?
“Cushing’s DISEASE”
- Pituitary adenoma
- Ectopic ACTH syndrome
the main causes of acth-independant hypercortisolism?
Cushing’s SYNDROME
- adrenal adenoma or carcinoma
- administration of glucorticoids (iotrogenic cause, side effect of tx)
- acth independant nodular hyperplasia
presenting features of a patient with cushing’s syndrome/disease?
moon face, obesity, hypertension, menstrual disorders, hirsutism, weakness, violaceous striae, bruisability, osteoporosis, ankle oedema, buffalo hump (fat pad on back of neck), acne
Diagnosis by hormone measurement:
- involves running an assay of both the hormone and the [regulated metabolite]. For example, Calcium and [….]. Or [….] and insulin.
- assay of hormone and tropic factor, for example {…} and TSH; cortisol and [….]; oestrogen and [….]; tostosterone and […].
- stimulation assay in cases of [….]activity or suppression test in cases of [….]activity.
- 24hour urine test
PTH
glucose
fT4
ACTH
FSH/LH
LH
hypo
hyper
in investigation of Cushing’s disease, a [….] would prove if the negative feedback loop is normal functioning or not.
dexamethasone suppression test
a patient with cortisol insufficiency would present with what possible symptoms?
- GI symptoms (anorexia, nausea, vomiting, diarrhea. weight loss)
- hypotension (salt wasting)
- darkening of skin (if acth secretion is stimulated)
- muscle weakness (skeletal and cardiac)
- increased susceptibility of infection
-DEATH (whoops, you missed the diagnosis)
primary causes of adrenocortical insufficiency?
“addison’s disease”
- genetic: enzyme defect in cortisol biosynthesis; metabolic defect ex adrenleukodystrophy
- autoimmune adrenal destruction
- infection disease: adrenal destruction by Tuberculosis
how does the salt-wasting state in addison’s disease cause hypotension?
salt-wasting leads to low serum sodium and high serum potassium—>inability to maintain hydrostatic pressure
addisonian pigmentation?
patients present with hyperpigmentation of knuckles of hands, knees, gums and oral mucosa.
sometimes present with vitiligo which is patchy white skin, loss of pigmentation in areas.
primary cause of congenital adrenal hyperplasia (CAH)?
due to 21-hydroxylase defect in 90% of cases.
- autosomal recessive
- impairment of cortisol and aldosterone synthesis
