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Endocrinology > Disorders of the Adrenal Glands > Flashcards

Disorders of the Adrenal Glands Flashcards

1
Q

What are the two types of corticoadrenal insufficiency?

A

Chronic Adrenocortical Insufficiency
Acute Adrenocortical Insufficiency

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2
Q

Chronic adrenocortical insufficiency can be further broken down into what categories?

A

Primary Insufficiency
Secondary Insufficiency
Tertiary adrenal insufficiency

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3
Q

Which type of chronic adrenocortical insufficiency is described below?

Addison’s disease

A

Primary Insufficiency

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4
Q

Which type of chronic adrenocortical insufficiency is described below?

Disorder resides in the pituitary gland

A

Secondary Insufficiency

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5
Q

Which type of chronic adrenocortical insufficiency is described below?

Disorder resides in the hypothalamus

A

Tertiary adrenal insufficiency

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6
Q

What is the most common cause of tertiary adrenal insufficiency?

A

Suppression of the hypothalamic-pituitary-adrenal function by chronic administration of high doses of glucocorticoids is the most common cause of tertiary adrenal insufficiency

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7
Q

What is the most common cause of Addison’s disease (Primary Insufficiency?

A

Autoimmune destruction

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8
Q

Caused by destruction or dysfunction of the adrenal cortices
(autoimmune)

A

Addison’s Disease

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9
Q

TB is a leading cause of this endocrine disorder in the areas
where it is prevalent

A

Addison’s Disease

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10
Q

What is a distinct clinical finding in Addison’s disease that is not seen in secondary or tertiary adrenal insufficiency?

A

Hyperpigmentation especially in creases, pressure areas, and nipples (due to increased ACTH secretion)

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11
Q

Skin pigmentation changes in Addison’s is due to what?

A

Chronic deficiency of cortisol with consequent elevation of serum
ACTH

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12
Q

What is diagnostic for Addison’s disease?

A

Low plasma cortisol (<3 mcg/dL) at 8am is diagnostic with a
simultaneous elevated in plasma ACTH (≥200pg/mL)

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13
Q

What is the confirmation test used in Addison’s disease?

A

Proven by cosyntropin (ACTH) stimulation test

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14
Q

What is the drug of choice in the treatment of Addison’s disease?

A

Hydrocortisone

Most maintained with 15-30mg of hydrocortisone in two divided doses

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15
Q

What is the most common cause of secondary insufficiency?

A

Withdrawal of long-term exogenous treatment that has suppressed ACTH (glucocorticoids)

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16
Q

What clinical finding is different in secondary insufficiency from primary insufficiency?

A

Secondary insufficiency will have pallor instead of hyperpigmentation

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17
Q

ACTH is low
Cortisol levels are low

A

secondary insufficiency

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18
Q

ACTH is elevated
Cortisol levels are low

A

Primary Insufficiency – Addison’s Disease

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19
Q

Emergency caused by insufficient cortisol

May occur during treatment of chronic insufficiency

May be presenting manifestation of adrenal insufficiency

A

Adrenal Crisis – Acute Adrenocortical Insufficiency

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20
Q

What complication is more common in primary insufficiency than in secondary?

A

Adrenal Crisis – Acute Adrenocortical Insufficiency

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21
Q

List some clinical findings of acute adrenocortical insufficiency

A

Elevated temperature of 105F (40.6C) or more

Low blood pressure

Cyanosis

Dehydration

Hypoglycemia and reduced insulin use in DM1 patients

Skin hyperpigmentation

Sparse axillary hair

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22
Q

Cortisol is low
ACTH is high or low depending on the underlying cause

A

Acute Adrenocortical Insufficiency

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23
Q

Symptoms and syndromes caused by excessive cortisol

A

Hypercortisolism

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24
Q

Which hypercortisolism condition is described below?

Excessive corticosteroids

Commonly due to supraphysiologic doses

Rarely due to spontaneous production of the renal cortex

A

Cushing Syndrome

25
Q

Which hypercortisolism condition is described below?

Hypercortisolism due to ACTH hypersecretion by the pituitary

Benign pituitary adenoma

3x more common in women

A

Cushing’s Disease (40%)

26
Q

Which hypercortisolism condition is described below?

Small cell lung carcinoma

Excessive amounts of ectopic ACTH

Hyperpigmentation and hypokalemia

A

Nonpituitary ACTH secreting neoplasms (10%)

27
Q

Which hypercortisolism condition is described below?

Secretion of cortisol by adrenals

Independent of ACTH

Most cases due to unilateral adrenal tumor

A

Excessive autonomous secretion (30%)

28
Q

List some findings you’d see in hypercortisolism?

A

Plethoric moon face
Buffalo hump
Supraclavicular fat pads
Purple striae
Proturberant abdomen and thin extremities (central obesity)
Muscle wasting
Acne
Superficial skin infections
Thin skin
hirsutism
Psychological changes
Amenorrhea or oligomenorrhea
Erectile dysfunction
Weakness
Back pain
Headache
HTN
Osteoporosis
Avascular bone necrosis
Easy bruisability
Impaired wound healing

29
Q

What are some ACTH independent causes of hypercortisolism?

A

Exogenous glucocorticoids
Adrenal adenoma
Adrenal corticocarcinoma

30
Q

What are some ACTH dependent causes of hypercortisolism?

A

Pituitary tumor
Ectopic ACTH secretion

31
Q

What is the characteristic lab finding of hypercortisolism?

A

Elevated serum cortisol and urinary free cortisol

32
Q

What is the screening test for hypercortisolism?

A

Dexamethasone Suppression Test

33
Q

What other diagnostic test for hypercortisolism has the same value in diagnostic as suppression test?

A

24 Hour Urinary Free Cortisol

34
Q

What are acutely critical for maintenance of life?

A

Mineralocorticoids

35
Q

Which type of hyperaldosteronism is described below?

Common

5-10% of all HTN cases

Can be seen in all ages (Peak incidence 30-60 year olds)

Excessive aldosterone production

More commonly caused by adrenal adenoma and uni/bilateral adrenal hyperplasia

A

Primary Aldosteronism

36
Q

Which type of hyperaldosteronism is described below?

underperfusion of the kidney – leads to increased renin production

A

Secondary Aldosteronism

37
Q

Elevated plasma and urine aldosterone levels

Low plasma renin level

A

Primary Aldosteronism

38
Q

Elevated plasma and urine aldosterone levels

High plasma renin level

A

Secondary Aldosteronism

39
Q

What are some signs/symptoms of primary aldosteronism?

A

Hypertension (may be severe or drug resistant)
Hypokalemia (especially in the absence of diuretics)
Muscular weakness
Polyuria
polydipsia

40
Q

Which labs should be assessed in screening for aldosteronism?

A

renin level

41
Q

What is the pathophysiology for secondary aldosteronism?

A

underperfusion of the kidney – leads to increased renin production

42
Q

List some common causes of underperfusion of the kidneys

A

Renal artery stenosis (MC)
Hypovolemia
Congestive heart failure

43
Q

What is the most common cause of underperfusion of the kidneys in secondary aldosteronism?

A

Renal artery stenosis

44
Q

Tumor of the sympathetic nervous system

Rare tumor, yet deceptive and deadly - lethal unless diagnosed and treated appropriately

Catecholamine-secreting tumors that arise from the chromaffin cells of the adrenal medulla

A

Pheochromocytoma

45
Q

The majority of pheochomocytomas arise from which part of the adrenal gland?

A

Arise from adrenal medulla (80%)

46
Q

Pheochromocytomas secrete what substance(s)?

A

catecholamines – epinephrine and norepinephrine

47
Q

Familial pheochromocytomas are usually what in 70% of cases

A

bilateral

48
Q

Pheochromocytomas may be associated with what diseases/syndromes?

A

May be associated with von Hippel-Lindau disease, neurofibromatosis, or MEN-2 syndromes

49
Q

“Attacks” of headache, perspiration, palpitations, anxiety should make you consider what in your differential diagnoses?

A

pheochromocytoma

50
Q

What are some triggers in pheochromocytomas?

A

IV contrast dyes
Glucagon injections
Needle biopsy of mass
Anesthesia
Surgical procedures
Drugs
Paroxysm triggers (lifting, bending, emotional stress, etc)

51
Q

What are the Rule of 10s in pheochromocytomas?

A

10% normotensive
10% in kids
10% familial
10% bilateral
10% extradrenal

52
Q

List some signs and symptoms you’d expect to see with a pheochromocytoma

A

HTN (90%)
Severe HA (80%)
Perspiration (70%)
Palpitations (60%)
Anxiety (50%)
Sense of doom or tremor (40%)
Forceful heartbeat +/- tachycardia
Fatigue/exhaustion
Abdominal pain
Nausea and vomiting
chest pain
Visual disturbance

53
Q

What is the classic triad of a pheochromocytoma?

A

Episodic headache
Sweating
tachycardia

54
Q

What are the 5 P’s of a pheochromocytoma?

A

Pressure (blood) - Sustained or paroxysmal HTN is the most common sign

Pain (headache)

Perspiration

Palpitations

Pallor

55
Q

Which patients should be screened for a pheochromocytoma?

A

Young hypertensives, particularly with episodic hypertension and severe uncontrollable hypertension

Family history of pheochromocytoma or medullary carcinoma of thyroid

Mucosal neuromas

Incidentally discovered adrenal tumors

56
Q

A positive lab finding of what highly suggests a pheochromocytoma?

A

Vanillylmandelic acid (VMA)

57
Q

What are some consequences of a pheochromocytoma?

A

Severe hypertensive consequences
Cardiomyopathy
Sudden blindness
Cerebrovascular accidents

58
Q

What is the ONLY treatment of a pheochromocytoma?

A

Surgical removal

59
Q

Rare tumor

Usually occurs in adults (median age of diagnosis is 44)

Typically an aggressive cancer

Most are found because excess hormone production causes symptoms (~60%)

Exact cause unknown

A

Adrenal Carcinoma

Endocrinology (7 decks)

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