Disorders of the Adrenal Glands Flashcards
clinical manifestations (S&S) due to hypercortisolism (excessive glucocorticoids)
cushing syndrome
what is the most common cause of cushing syndrome?
exogenous steroid drugs
what is the most common cause of spontaneous cushing syndrome?
cushing disease
what is the 2nd most common cause of cushing syndrome?
adrenal tumor
ACTH hypersecretion by the pituitary due to very small benign pituitary adenoma
cushing disease
a patient presents with central obesity, moon face, buffalo hump, purple striae, slow wound healing, muscle weakness, depression, hypertension, DM, menstrual irregularities, and decreased libido. what are they likely experiencing?
Cushing syndrome
what are 2 screening tests for Cushing syndrome?
dexamethasone suppression test
24 hr urine of cortisol and creatinine
what level of ACTH after a dexamethasone suppression test would indicate positive Cushing syndrome?
over 5
where is the problem if serum ACTH is low? what would we order?
adrenal glands
CT of adrenal
where is the problem if serum ACTH is high? what would we order?
pituitary gland
MRI of pituitary
what are 2 things that could cause high serum ACTH?
pituitary tumor
ectopic tumor
what would labs look like in Cushing syndrome? (5)
elevated serum + urine cortisol
ACTH varies
glycosuria
leukocytosis
hypokalemia
what is the treatment for Cushing Disease/ACTH dependent?
transphenoidal selective resection of pituitary adenoma
what is the treatment for an adrenal adenoma/ACTH independent?
unilateral adrenalectomy
what can patients develop with resection of pituitary, ectopic tumor, or adrenalectomy? what will the patient need?
cortisol withdrawal
hydrocortisone
what is the treatment for hypercortisolism when surgery is delayed, CI, or unsuccessful?
“block and replace”
adrenal enzyme inhibitor (ketoconazole) - block
hydrocortisone - replace
when the adrenal cortex is absent, destroyed, or dysfunctional and cannot make cortisol or aldosterone
primary adrenal insufficiency (AKA Addison Disease)
what is the most common cause of Addison Disease in the US?
autoimmune destruction
what is the most common cause of Addison Disease in the rest of the world?
infectious TB
a patient presents with fatigue, anorexia, N/V/D, headache, abdominal pain, weight loss, arthralgias, depression, and salt cravings. they also have hypotension and tachycardia. what are they likely experiencing?
primary adrenal insufficiency (Addison)
what symptom of primary adrenal insufficiency may precede all other symptoms by months to years?
hyperpigmentation
what causes hyperpigmentation in Addison’s disease?
excess ACTH on melanocytes
what will labs look like in a patient with primary adrenal insufficiency? (4)
low cortisol
high ACTH
low Na
high K
how would DHEA and PRA present in a patient with primary adrenal insufficiency?
low serum DHEA
elevated PRA
what diagnostic would we want to get if the primary adrenal insufficiency is not due to an autoimmune cause?
chest CT
what is the imaging of choice to evaluate adrenal insuffiency?
CT adrenals
what imaging is helpful in diagnosing the etiology of adrenal disease?
CT adrenals + FNA
what will be found in a CT adrenals + FNA if the adrenal insufficiency is due to an autoimmune cause?
lymphocytes
what will be found in a CT adrenals + FNA if the adrenal insufficiency is due to TB?
granulocytes
what will be found in a CT adrenals + FNA if the adrenal insufficiency is due to a neoplasm?
mets
what will be found in a CT adrenals + FNA if the adrenal insufficiency is due to a hemorrhage?
blood
low ACTH, normal pigmentation and normal aldosterone production indicates what?
secondary adrenal insufficiency
what is the treatment for all forms of adrenal insufficiency?
glucocorticoid replacement
what specific medications can be used to treat chronic primary adrenal insufficiency? (3)
hydrocortisone
dexamethasone
prednisone
what medication can be used for a patient with primary adrenal insufficiency that has hypotension, salt cravings, or hyponatremia?
fludrocortisone (mineralcorticoid replacement)
what can be given to women with primary adrenal insufficiency + impaired mood or sense of well being, despite optimal glucocorticoid and mineralcorticoid replacement?
DHEA
what should be done when a patient with adrenal insufficiency develops a febrile illness, needs a surgical procedure, or has an increased stress like serious illness or divorce?
give 2-3 times usual maintenance glucocorticoid dose for 3 days
acute adrenal insufficiency = _____ = _____
adrenal crisis
emergency
a patient presents with N/V, abdominal pain, hypotension, fever, hyponatremia, hyperkalemia, and hypoglycemia. what are they likely experiencing?
adrenal crisis
what is the treatment for adrenal crisis? (2)
stress dose of IV hydrocortisone (100-300mg)
rapid bolus of normal saline
what can be given to a patient in adrenal crisis who has hypoglycemia?
normal saline + dextrose
what should ALL patients experiencing an adrenal crisis receive?
empiric antibiotics
tumor in the adrenal medulla that secretes epinephrine and NE
pheochromocytoma
what is the classic triad of symptoms for pheochromocytoma?
headache
palpitations
diaphoresis
why is diagnosis critical in pheochromocytosis?
condition can lead to fatal hypertensive crisis + cardiac arrythmias
what will labs look like in pheochromocytoma? (2)
elevated plasma metanephrines during spell
high urine catecholamines
what diagnostics can we do to look for tumor in adrenal medulla for pheochromocytoma? (2)
abdominal MRI/CT
nuclear imaging
what is the treatment of choice for pheochromocytoma?
adrenalectomy
what is the pre-op treatment for pheochromocytoma (before adrenalectomy)?
alpha blocker OR CCB (10-14 days)
BB for tachycardia (AFTER HTN IS RESOLVED)
when can a beta blocker be started for a patient with pheochromocytoma PRE-OP?
only after hypertension is resolved
