Endo II - Adrenal Disorders

Question 1

what hormones are produced in the:
zona gomerulosa
zona fasicularis
zona reticularis
adrenal medulla

Answer 1

G - mineralocorticoids
F - glucocorticoids
R - androgens
M - catecholamines

Question 2

moon face
striae
depression
HTN
DM
hyperpigmentation
menstural abnormalities

Answer 2

Cushing disease
increased ACTH from pituitary

Question 3

exogenous cushing syndrome - what results in adrenal glands

Answer 3

bilateral adrenal atrophy

Question 4

cushing disease - pituitary tumour

Answer 4

bilateral adrenal hyperplasia

Question 5

primary hypecortisolism

Answer 5

atrophy contralateral adrenal gland

Question 6

ectopic ACTH production

Answer 6

bilateral adrenal hyperplasia

Question 7

tests for hypercortisolism

Answer 7

urine cortisol
dexamethasone suppression test

Question 8

plasma cortisol increased
urine free cortisol increased
LD DST not suppressed
HD DST suppressed
plasma ACTH increased

Answer 8

pituitary cause - cushing syndrome

Question 9

plasma cortisol increased
urine free cortisol increased
LD DST not suppressed
HD DST suppressed
plasma ACTH decreased

Answer 9

adrenal cause - cushing syndrome

Question 10

plasma cortisol increased
urine free cortisol increased
LD DST not suppressed
HD DST suppressed
plasma ACTH increased+

Question 11

triad of hypertension, hypokalaemia, metabolic alkalosis

Answer 11

hyperaldosteronism

Question 12

hyperaldosteronism:
low renin
high aldosterone
= 1’ or 2’

Answer 12

primary hyperaldosteronism (Conn syndrome)

Question 13

hyperaldosteronism:
high renin
high aldosterone
= 1’ or 2’

Answer 13

secondary hyperaldosteronism
extra adrenal cause

Question 14

kidney responds to hyperaldosteronism via aldosterone escape - excretes sodium in urine. It presents as:

Answer 14

hypertension without oedema / hypernatremia
Na+ - high
K+ - low
HCO3 - high

Question 15

Exaggerated features male & women
Hairiness face / body
Baldness
Acne
Deeper voice
Muscularity
Hirsutism / virilisation in females

Answer 15

androgen excess

Question 16

what enzyme defects occur in congenital adrenal hyperplasia

Answer 16

17B-hydroxylase
21B-hydroxylase
11B-hydroxylase

Question 17

enzyme deficiency:
increased aldosterone
increased DOC
increased cortisol
decreased androgen

Answer 17

17B-hydroxylase

Question 18

increased androgens
decreased cortisol
decreased aldosterone
decreased DOC

Answer 18

21B-hydroxylase

Question 19

1increased androgens
increased DOC
decreased cortisol
decreased aldosterone

Answer 19

11B-hydroxylase

Question 20

infant/child
failure to thrive
aldosteron & cortisol deficiency
increased androgens
hyponatremia
hyperkalaemia
serum 17 Oh progesterone test - >1500ng/mL

Answer 20

21 hydroxylase deficiency
classic - salt loosing

Question 21

Infants/child
Simple virilization
Increase androgens
Only Cortisol deficiency
Early growth of pubic
and axillary hair
serum 17 Oh progesterone test - >1500ng/mL

Answer 21

21 hydroxylase deficiency
classic - non-salt loosing

Question 22

Adolescence
Typical genitalia
Primary menorrhea
Acne
Hirsutism
Polycystic ovaries
Serum 17 OH progesterone test - >200 ng/mL

Answer 22

21 hydroxylase deficiency
non-classic

Question 23

17 hydroxyprogesterone - elevated
ACTH - elevated
coristol, androgen, oestrogen - low

Answer 23

17 alpha hydroxylase deficiency

Question 24

11 droxycorticosterone - high
ACTH - absent/low
renin - low

Answer 24

11B-hydroxylase deficiency

Question 25

name a condition causing 1', 2', 3' adrenocortical insufficiency

Answer 25

1' - waterhouse Friderichsen syndrome 2' pituitary tumour 3' withdrawal glucocorticoids

Question 26

hypoglycaemia hypotension, shock, dizziness skin hyperpigmentation peptic ulcers

Answer 26

hypocortisolism

Question 27

must increase ____ during surgery or vitals drop due to ____ condition

Answer 27

cortisol hypocortisolism

Question 28

decreased Na reabsorption hypotension increased salt craving low BP hyperkalaemia metabolic acidosis

Answer 28

hypoaldosteronism

Question 29

decreased DHEA loss axillary / pubic hair loss libido

Answer 29

hypoandrogenism

Question 30

overnight metyrapone stimulation test in adrenal insufficiency

Answer 30

low 11-deoxycortisol low cortisol high ACTH

Question 31

rapid withdrawal steroids fever vomiting diarrhoea severe abdominal pain high --> low ACTH high cortisol

Answer 31

**adrenal crisis** also occurs following; pituitary apoplexy infection GIT illness hyperthryroidism

Question 32

neisseria meningitidis children acute, bilateral haemorrhagic infarction adrenal cortex fever, neck stiffness, petechial rash, DIC leucocytosis, thomrbocytopaenia low cortisol low aldosterone

Answer 32

Waterhouse-Friderichsen syndrome

Question 33

Cosyntropin test (CST): Negative result = cortisol level stimulation >500-600nmol/L

Answer 33

normal functioning

Question 35

AD, Incomplete penetrance Proliferative lesions - hyperplasia & endocrine gland tumours Young Aggressive (more than sporadic) Multiple endocrine organs involved

Answer 35

MENs syndrome

Question 36

Primary hyperparathyroidism Pituitary tumours Enteropancreatic tumours wermer syndrome what is the mutation?

Answer 36

MENIN-1 in MEN-1 syndrome

Question 37

Parathyroid Pheochromocytoma Medulla carcinoma - thyroid Sipple syndrome - what is the mutation?

Answer 37

RET mutation in MEN-2A

Question 38

Pheochromocytoma Medulla carcinoma - thyroid Mucosal neuroma Marfanoid habitus Sipple syndrome - what is the mutation?

Answer 38

RET mutation in MEN-2B