Endo

Question 1

• Catecholamine secreting adrenal tumor–>secretes epi and norepi (90% benign)
• Sx HTN (secondary), PHE (palpitations, HA, excessive sweating)
• Dx: 24hr catecholamines w/ metabolites; MRI/CT to visualize tumor
• Tx: Adrenalectomy

Answer 1

Pheochromocytoma

Question 2

Idiopathic, bilat adrenal hyperplasia (renin independent)
MC in women
Sx: Asx to HTN (DBP often raised more than SBP), hypokalemia (Sx: proximal muscle weakness, polyuria, fatigue, decreased DTRs)
-Dx: Hypokalemia w met. alkalosis; aldosterone/Renin ratio; MRI/CT
-Tx: Spironolactone, ACEI, CCB, excision of aldosteromas

Answer 2

Hyperaldosteronism (primary)

Question 3

• Hypercortisolism. MC d/t long-term high dose exogenous steroid use. 1/3 d/t autonomous adrenal cortisol secretion, indep. of adrenocorticoptropic hormone (ACTN.
• Sx: Central obesity, HTN, thirst, polyuria, moon fancies, buffalo hump, striae, proximal muscle weakness, oligomenorrhea/amenorrhea
• Dx: Mexamethasone suppression test; urine (24hr) cortisol levels, salivary cortisol levels
• Tx: Tumor removal, ketoconazole (decreases cortisol production)

Answer 3

Cushing Syndrome

Question 4

• Adrenocroticoptropic hormone excess. Usually 2/2 ACTH secreting pituitary tumor.
• Women>men
• Sx: Central obesity, HTN, thirst, polyuria, moon fancies, buffalo hump, striae, proximal muscle weakness, oligomenorrhea/amenorrhea
• Dx: Mexamethasone suppression test; urine (24hr) cortisol levels, salivary cortisol levels
• Tx: Tumor removal, ketoconazole (decreases cortisol production)

Answer 4

Cushing Disease

Question 5

Primary causes: Adrenal destruction d/t: 1) autoimmune (MC in industrialized countries) or 2) Infx (MC worldwide) 3) vascular insufficiency 4) metastatic Dz (Primary=addison’s disease)

Secondary: Failure of ACTH release d/t 1)exogenous steroids 2) hypopituitary

Secondary > Primary

Answer 5

Chronic Adrenal insufficiency

Question 6

Insidious onset of nondescript symptoms. Most telling are hyper pigmentation, decreased aldosterone and decreased female sex hormones
-Dx: High dose ACTH stimulation Test
Tx: HRT

Answer 6

Chronic Adrenal Insufficiency

Question 7

-Sudden worsening of adrenal insufficiency 2/2 stressful events (surgery, trauma, infx, etc)
-MC seen 2/2 withdrawal of exogenous steroids
-Sx: Shock, hypotension, hypovolemia, n/v, lethargy
-Dx: Cortisol levels
Tv: IVF, steroids

Answer 7

Acute adrenal insufficiency

aka

Adrenal (Addisonian) Crisis