Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endocrinology > Disorders of the Adrenal Cortex > Flashcards

Disorders of the Adrenal Cortex Flashcards

1
Q

Cortex is split up into 3 zones =

A

Zona glomerulosa
Zona fasciculata
Zona reticularis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What hormones are made in the Zona glomerulosa

A

Mineralocorticoids - Aldosterone and corticosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What hormones are made in the Zona fasciculata

A

Glucocorticoids - cortisol and cortisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What hormones are made in the Zona reticularis

A

Androgens - testosterone and estrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Adrenal hormones include: (4 S’s)

A

Aldosterone = SALT
Cortisol = SUGAR
Androgens = SEX
Epi, Norepi = STRESS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Adrenal Disorders are categorized as:

A

Hyper / Hypofunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hyperfunctional Adrenal gland results in

A

hormone excess (autoimmune disorders, neoplasms, exogenous administration)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hypofunctional Adrenal gland results in

A

hormone deficiency (autoimmune, infection, surgery, inflammation, infarction, hemorrhage or tumor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Adrenal disorders:
Cushing’s syndrome
Pheochromocytoma
Multiple endocrine neoplasia
Adrenal Adenoma
Adrenal Cancer

A

Hyperfunctioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Adrenal disorders:
Addison’s Disease
Adrenal Deficiency

A

Hypofunctioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Cushing syndrome - Pathophysiology

A

CUshing Syndrome = Cortisol Unchecked
Excess blood glucose production (excess gluconeogenesis; decreased Glycolysis for brain food)
increase in lipolysis
increase in protein catabolism
decrease insulin production and increased glucagon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pathognomonic symptoms:
Central obesity
rounded face (moon facies)
Enlarged fat pad between shoulders (buffalo hump - dorsocervical area)
abdominal striae (purple stretch marks)
thinning skin
easy bruising

A

Cushing syndrome presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

ACTH is released from where in the body

A

Pituitary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What stimulates ACTH to be released

A

CRH from the hypothalamus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Two types of Cushing’s Syndromes

A

iatrogenic - exogenous corticosteroid administration
ACTH dependent - problem in the pituitary
ACTH independent - problem in the adrenal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cushing’s Syndrome workup (screening):

A

screening - elevated 24 hour urine free cortisol

elevated midnight plasma cortisol (normally time of lowest cortisol secretion)

Dexamethasone suppression test (should reduce steroid levels - positive is the cortisol levels have not reduced)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Cushing’s Syndrome workup (if screening is positive):

A

Plasma ACTH
determines if ACTH dependent or independent etiology
>15 pg/mL = ACTH dependent (problem is in the pituitary)
< 5 pg/mL = ACTH independent (problem is the adrenal gland)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Localizing the source for ACTH independent

A

CT of the adrenals
usually benign masses = think malignancy if > 4cm, usually atypically densities or contrast irregularities

19
Q

Localizing the source for ACTH dependent

A

MRI of the pituitary if no lesion there –> look for ectopic source =
CT scan of the chest, abdomen, thymus, pancreas and/or adrenals

20
Q

Treatment for Cushing’s Syndrome

A

Pituitary source - transsphenoidal resection of mass
Ectopic ACTH-secreting tumors - local surgical resection, if failed or not feasible - bilateral adrenalectomy and replacement hormones
Benign adrenal adenoma - laparoscopic resection (masses < 6cm)
Adrenal Carcinoma - surgical resection
symptomatic treatment if surgical treatment not feasible or declined

21
Q

What is a pheochromocytoma

A

sympathetic nervous system arising from the adrenal medulla
catecholamine secreting - epinephrine or norepinephrine

22
Q

Presentation:
HA
profuse sweating
palpitations and tachycardia
HTN, sustained or paroxysmal (new onset high HTN)
anxiety and panic attacks
(Variable presentation)

A

Pheochromocytoma

23
Q

Classic Triad of PHEochromocytoma

A

Palpitations
HA
Episodic sweating

Diagnosis likely if all three + HTN

24
Q

Catecholamine pulses are released but with no ________

A

correlated cause

this is why it can be misdiagnosed as an anxiety attack

25
Q

Pheochromocytoma can result in

A

catastrophic HTN crisis
fatal arrhythmias
pulmonary edema or HF
ARDS and multisystem failure

26
Q

Pheochromocytoma workup (labs)

A

lab testing - plasma fractionated free metanephrines (most sensitive)
specimen obtained after sitting quietly for 15 mins
if positive - retest after lying supine in a quiet room 30-90 min
confirm with 24 hr urine for fractionated metanephrines and creatine

27
Q

Pheochromocytoma workup (imaging)

A

non-contrast abdominal CT
MRI with or without gadolinium contrast

28
Q

Pheochromocytoma treatment

A

surgical resection (partial or total - laparoscopic preferred)
alpha blockers or CCB for HTN
beta blockers for arrhythmia
caution - treatment resistant hypotension post-op
if malignant - add chemo, recheck BP and plasma free metanephrines, follow with serum chromogranin A (CgA)

29
Q

Four distinct types of Multiple Endocrine Neoplasia (MEN)

A

MEN 1
MEN 2 (2A)
MEN 3 (2B)
MEN 4

30
Q

MEN 1 presentation

A

classic triad of tumors - parathyroids, pancreatic islets, anterior pituitary
hyperparathyroidism is the initial presenting sx

31
Q

MEN 2 (2A) presentation

A

classic triad - medullary thyroid carcinoma, pheochromocytomas, parathyroid tumors

32
Q

MEN 3 (2B) presentation

A

characterized by mucosal neuromas
marphan-like habitus
delayed puberty, skeletal abnormalities
pheochromocytoma - 60%

33
Q

MEN 4 presentation

A

most rare of the MEN subsets
often pituitary, parathyroid, pancreatic tumors

34
Q

MEN workup

A

primary diagnostic tool is genetic testing
screening for patients with known FH
screening for neuroendocrine tumors with targeted tests/ imaging (MRI for pituitary and adrenal tumors)

35
Q

MEN treatment

A

Parathyroidectomy if sx
prophylactic thymectomy if getting parathyroidectomy
high dose PPIs and control hypercalcemia if gastrinomas
+/- chemo

36
Q

Classical presentation of Adrenal Insufficiency

A

fatigue
reduced stamina
weakness
anorexia/ wt loss

37
Q

Adrenal Insufficiency is

A

deficiency of the adrenal cortex hormones
primary and secondary causes

38
Q

Primary adrenal disease is aka

A

addison’s disease (adrenal deficiency)
Primarily autoimmune in origin

39
Q

Acute adrenal crisis is

A

life threatening
more common with primary insufficiency
N/V, fever, dehydration, profound hypotension
progression to shock unresponsive to fluids or vasopressors

40
Q

Adrenal Insufficiency workup labs

A

plasma cortisol < 3 mcg/mL is diagnostic
often low serum DHEA levels but non-specific
conformation with cosyntropin stimulation test (synthetic ACTH) - must hold exogenous steroid meds

41
Q

Differentiating between primary and secondary adrenal insufficiency

A

Plasma ACTH differentiates between primary and secondary insufficiency
High > 200 pg/mol = primary insufficiency
Low or normal = secondary insufficiency

42
Q

Adrenal insufficiency workup imaging

A

MRI of hypothalamus and pituitary to look for masses
CT of the adrenals for cases of primary insufficiency that are not dx with antibody testing - small noncalcified adrenals in autoimmune, enlarged adrenals in metastatic or granulomatous disease

43
Q

Adrenal insufficiency treatment

A

Glucocorticoid replacement therapy
15-30 mg hydrocortisone daily 2-3 doses
alternatives prednisone or methylprednisolone
increased doses when under stress
Mineralocorticoid replacement therapy
+DHEA supplementation for women

44
Q

Treatment for adrenal crisis

A

loading dose of hydrocortisone 100-300 mg IV
Re-hydration with saline solution
Hydrocortisone 50-100 mg q6h IV, titrate down and to PO as able
broad spectrum abx until infection is ruled out as cause

Endocrinology (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions