Disorders of the Adrenal Glands Flashcards by Katie Keller

What are the two types of corticoadrenal insufficiency?

Chronic Adrenocortical Insufficiency
Acute Adrenocortical Insufficiency

How well did you know this?

Not at all

Perfectly

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

Primary Insufficiency
Secondary Insufficiency
Tertiary adrenal insufficiency

How well did you know this?

Not at all

Perfectly

Which type of chronic adrenocortical insufficiency is described below?

Addison’s disease

Primary Insufficiency

How well did you know this?

Not at all

Perfectly

Which type of chronic adrenocortical insufficiency is described below?

Disorder resides in the pituitary gland

Secondary Insufficiency

How well did you know this?

Not at all

Perfectly

Which type of chronic adrenocortical insufficiency is described below?

Disorder resides in the hypothalamus

Tertiary adrenal insufficiency

How well did you know this?

Not at all

Perfectly

What is the most common cause of tertiary adrenal insufficiency?

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

How well did you know this?

Not at all

Perfectly

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

Autoimmune destruction

How well did you know this?

Not at all

Perfectly

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

Addison’s Disease

How well did you know this?

Not at all

Perfectly

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

Addison’s Disease

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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

Chronic deficiency of cortisol with consequent elevation of serum
ACTH

How well did you know this?

Not at all

Perfectly

What is diagnostic for Addison’s disease?

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

How well did you know this?

Not at all

Perfectly

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

Proven by cosyntropin (ACTH) stimulation test

How well did you know this?

Not at all

Perfectly

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

Hydrocortisone

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

How well did you know this?

Not at all

Perfectly

What is the most common cause of secondary insufficiency?

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

How well did you know this?

Not at all

Perfectly

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

Secondary insufficiency will have pallor instead of hyperpigmentation

How well did you know this?

Not at all

Perfectly

ACTH is low
Cortisol levels are low

secondary insufficiency

How well did you know this?

Not at all

Perfectly

ACTH is elevated
Cortisol levels are low

Primary Insufficiency – Addison’s Disease

How well did you know this?

Not at all

Perfectly

Emergency caused by insufficient cortisol

May occur during treatment of chronic insufficiency

May be presenting manifestation of adrenal insufficiency

Adrenal Crisis – Acute Adrenocortical Insufficiency

How well did you know this?

Not at all

Perfectly

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

Adrenal Crisis – Acute Adrenocortical Insufficiency

How well did you know this?

Not at all

Perfectly

List some clinical findings of acute adrenocortical insufficiency

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

How well did you know this?

Not at all

Perfectly

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

Acute Adrenocortical Insufficiency

How well did you know this?

Not at all

Perfectly

Symptoms and syndromes caused by excessive cortisol

Hypercortisolism

How well did you know this?

Not at all

Perfectly

Which hypercortisolism condition is described below?

Excessive corticosteroids

Commonly due to supraphysiologic doses

Rarely due to spontaneous production of the renal cortex

Cushing Syndrome

Which hypercortisolism condition is described below? Hypercortisolism due to ACTH hypersecretion by the pituitary Benign pituitary adenoma 3x more common in women

Cushing’s Disease (40%)

Which hypercortisolism condition is described below? Small cell lung carcinoma Excessive amounts of ectopic ACTH Hyperpigmentation and hypokalemia

Nonpituitary ACTH secreting neoplasms (10%)

Which hypercortisolism condition is described below? Secretion of cortisol by adrenals Independent of ACTH Most cases due to unilateral adrenal tumor

Excessive autonomous secretion (30%)

List some findings you'd see in hypercortisolism?

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

What are some ACTH independent causes of hypercortisolism?

Exogenous glucocorticoids Adrenal adenoma Adrenal corticocarcinoma

What are some ACTH dependent causes of hypercortisolism?

Pituitary tumor Ectopic ACTH secretion

What is the characteristic lab finding of hypercortisolism?

Elevated serum cortisol and urinary free cortisol

What is the screening test for hypercortisolism?

Dexamethasone Suppression Test

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

24 Hour Urinary Free Cortisol

What are acutely critical for maintenance of life?

Mineralocorticoids

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

Primary Aldosteronism

Which type of hyperaldosteronism is described below? underperfusion of the kidney – leads to increased renin production

Secondary Aldosteronism

Elevated plasma and urine aldosterone levels Low plasma renin level

Primary Aldosteronism

Elevated plasma and urine aldosterone levels High plasma renin level

Secondary Aldosteronism

What are some signs/symptoms of primary aldosteronism?

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

Which labs should be assessed in screening for aldosteronism?

renin level

What is the pathophysiology for secondary aldosteronism?

underperfusion of the kidney – leads to increased renin production

List some common causes of underperfusion of the kidneys

Renal artery stenosis (MC) Hypovolemia Congestive heart failure

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

Renal artery stenosis

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

Pheochromocytoma

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

Arise from adrenal medulla (80%)

Pheochromocytomas secrete what substance(s)?

catecholamines – epinephrine and norepinephrine

Familial pheochromocytomas are usually what in 70% of cases

bilateral

Pheochromocytomas may be associated with what diseases/syndromes?

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

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

pheochromocytoma

What are some triggers in pheochromocytomas?

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

What are the Rule of 10s in pheochromocytomas?

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

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

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

What is the classic triad of a pheochromocytoma?

Episodic headache Sweating tachycardia

What are the 5 P's of a pheochromocytoma?

Pressure (blood) - Sustained or paroxysmal HTN is the most common sign Pain (headache) Perspiration Palpitations Pallor

Which patients should be screened for a pheochromocytoma?

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

A positive lab finding of what highly suggests a pheochromocytoma?

Vanillylmandelic acid (VMA)

What are some consequences of a pheochromocytoma?

Severe hypertensive consequences Cardiomyopathy Sudden blindness Cerebrovascular accidents

What is the ONLY treatment of a pheochromocytoma?

Surgical removal

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

Adrenal Carcinoma