Endocrine 5 Flashcards
Conn’s Syndrome:
Primary Hyperaldosteronism is a rare disease that is typically caused by an adenoma of the _________ (70% of cases), whereas the remaining 30% have cortical hyperplasia.
Zona Glomerulosa
Clinical presentation of which condition?
retention of sodium and loss of potassium, accompanied by retention of water, resulting in hypertension (hypernatremic hypokalemic hypertension)
Conn’s Syndrome
How is Conn’s Syndrome treated?
Tx is surgery with complete cure
_________ is much more common than primary (Conn’s)
where the secretion of Aldosterone is physiologically stimulated by angiotensin (formed from angiotensinogen under the influence of renin)
Secondary Hyperaldosteronism
Secondary Hyperaldosteronism-
Renin is secreted from the _____ cells of the kidneys, and elevated levels of renin are typically found in various renal diseases.
J-G cells
Secondary Hyperaldosteronism is associated with ________, in contrast to primary (AKA Conn’s syndrome), which is renin-independent and associated with normal levels of renin in the circulation.
hyperreninemia
Is Conn’s syndrome renin independent or dependent?
Renin independent
How do you determine whether hyperaldosteronism is caused by renal or adrenal disease?
Blood test
(b/c renin and aldosterone measurements are in the blood)
Adrenogenital syndrome (Adrenal Virilism) is a rare disease that can affect _______ or ______
neonates or adults
The disease is typically found in______ (males or females) who experience what?
Females
who experience virilization due to an excess of adrenogenic hormones.
Which syndrome?
May be congenital or may develop in adulthood
In neonates, the disease is related to one of several inborn errors of steroid metabolism (i.e. 21-hydroxylase deficiency) that causes an overproduction of testosterone
Adrenogenital syndrome (Adrenal Virilism)
Which syndrome?
An excess in Androgens results in partial virilization of the external female genitalia causing:
- enlargement of the clitoris
- partial fusion of the labioscrotal folds.
Adrenogenital syndrome
(although they are genetically female, they are sometimes reared as males)
In adult women, Adrenogenital syndrome is related to _________
androgen producing tumors
Adrenogenital syndrome causes what 4 sxs in adult women?
- virilization
- hirsuitism
- deepening of the voice
- loss of menstruation
Adrenogenital syndrome-
what is treatment of adrenocortical hyperfunction
depends on the cause of the disease
usually involves surgical resection of hyperfunctioning tumors.
Adrenocortical hypofunction is usually a consequence of what 2 things
consequence of adrenal destruction:
- either acutely (Waterhouse-Freidreichsen’s Syndrome) OR
- slowly, owing to destruction of the adrenocortex by an autoimmune disease (Addison’s Disease)
Infections (TB or Histoplasmosis), primary or metastatic malignancies (Lung or Breast) may also destroy the adrenals, causing
insufficiency
Which dz accounts for the vast majority (70-80%) of adrenal insufficiency today
Addison’s Disease
Addison’s Disease accounts for the vast majority (70-80%) of adrenal insufficiency today, the remaining are still due to________, that affect the immunosuppressed (AIDS).
infections, such as TB or fungal diseases
T/F: malignant tumors are a common cause for Addison’s
FALSE
they are a rare cause for Addisons
Pathologically, the adrenal in Addison’s, early on, is characterized in infiltration of ______ and_______ in the cortex.
lymphocytes and plasma cells
Addison’s disease- In later stages, the entire cortex is destroyed and may be replaced by _______ or fat cells.
fibrous tissue
Clinically, Addison’s Disease presents with what 3 things? Affected patients are hypotensive.
- Fatigue
- Weight loss
- Nausea
(note that this is opposite from Cushing’s)
What is the name of the neoplasm of the adrenal medulla that synthesize and release Catecholamines (Epinephrine and Norepinephrine).
Pheochromocytoma
Pheochromocytoma: Although uncommon, they give rise to a surgically correctable form of _____.
HTN
Pheochromocytoma-
•____% are bilateral and _____% may arise from other sites (i.e. carotid body) where they are called Paragangliomas.
10% and 10%
Pheochromocytomas range from small, circumscribed lesions confined to the adrenal to ________
large hemorrhagic masses.
- They are tan-yellow, well-defined lesions that compress the adjacent adrenal, with varying amounts of hemorrhage.
- The larger lesions tend to have necrosis and large areas of hemorrhage.
Pheochromocytoma
Pheochromocytoma-
•The diagnosis of _______, which occurs in about 10% of pheochromocytomas, is based on the presence of_______.
malignancy, metastasis
Pheochromocytoma metastases may involve _________ as well as more distant sites, such as liver, lungs and bone.
regional lymph nodes
pheochromocytoma metastases involve which 3 distant sites?
- liver
- lungs
- bone
Dominant clinical manifestation is HTN, which is:
- abrupt,
- with tachycardia,
- palpitations,
- H/A,
- sweating
- tremor,
- often associated with N/V, abdominal, and chest pain.
Pheochromocytoma
What would you be concerned about if a patient is complaining of paroxysmal HTN only w/ exercise?
Pheochromocytoma
(just bending over can irritate pheo)
in how many patients w/ a pheochromocytoma does the hypertension occur in the form of chronic, sustained elevations in blood pressure.
2/3
in 1/3 of patients w/ pheochromocytoma, the HTN paroxysms may be precipitated by what 3 things?
- stress
- exercise
- change in posture
the elevations in blood pressure of a person w/ a pheochromocytoma are induced by what?
the sudden release of catecholamines.
Pheochromocytoma- the sudden release of catecholamines may acutely precipitate what 5 thngs
- pulmonary edema
- MI
- V-fib
- CVA
- CHF
In some cases, pheochromocytomas secrete other hormones, such as ______ and _______
may therefore be associated with clinical features related to these hormone secretions.
ACTH and Somatostatin
The lab diagnosis of pheochromocytoma is based on the demonstration of what?
increased urinary excretion of free catecholamines and their metabolites, such as Vanillylmandelic Acid (VMA’s) and Metanephrines.
Pheochromocytoma- isolated benign tumors are treated with what?
surgical excision after pre-operative and intraoperative medication with adrenergic blocking agents.
