Endocrine Part 1 Flashcards
Chronic Adrenocortical Insufficiency is a disorder in which
the adrenal gland does not produce enough hormones
Secondary adrenocortical insufficiency is when the
pituitary fails to secrete ACTH
Causes of secondary adrenocortical insufficiency
- Exogenous glucocorticoid use (MCC)
- Hypopituitarism
On the other hand, primary adrenal insufficiency is
Adrenal gland destruction, so a lack of cortisol AND aldosterone
True or False: In secondary adrenal insufficiency, there is a lack of cortisol only. The aldosterone is intact because of the renin angiotensin aldosterone system?
True!
Causes of primary adrenal insufficiency
- Autoimmune (MC)
- Infection (TB, HIV)
- Vascular
- Medications (Ketoconazole, Rifampin, Phenytoin)
Symptoms of adrenocortical insufficiency (lack of cortisol)
- Weakness, myalgias, fatigue
- Nonspecific GI symptoms
- Abnormal menstruation
- Mild hyponatremia, salt craving
- Hypotension
Symptoms in Primary (Addison’s Disease) due to lack of sex hormones and aldosterone
- Hyperpigmentation (increased ACTH stimulates melanocytes)
- Orthostatic Hypotension
- Loss of libido, amenorrhea, and loss of pubic hair in women
What do the labs show in Primary Adrenocortical insufficiency?
- Elevated ACTH
- Hyperkalemia, Metabolic Acidosis
What do the labs show for secondary adrenocortical insufficiency
- Decreased ACTH
- Hypoglycemia
What is the screening test for adrenal insufficiency?
- High dose ACTH stimulation test
- -This test is positive if insufficient or absent rise in serum cortisol ( < 18) after ACTH administration
Treatment for adrenal insufficiency
- Glucocorticoid replacement (Hydrocortisone)
- Mineralocorticoid replacement (Fludricortisone) ONLY in Addison’s
What are some patient education tips if they have adrenal insufficiency?
- Patients must be treated with IV glucocorticoids and IV isotonic fluids before and after surgery
- During illness/stress/surgery, oral dosing needs to be adjusted to triple the dose
- Everyone should carry a medical alert tag and injectable form of cortisol
Explain the pathophysiology of Adrenal (Addisonian) Crisis
-Triggered by a stressful event (trauma, illness, surgery) and usually the response is to increase cortisol by three-fold. Patients with this are unable to do so to meet the demand.
Etiologies of Addisonian Crisis
- Abrupt withdrawal of glucocorticoids (without tapering)
- Bilateral adrenal infarction
Symptoms of Addisonian Crisis
- Shock is the primary manifestation
- Hypotension
- Hypovolemia
What do labs show for Addisonian Crisis
- Hyponatremia
- Hyperkalemia
- Hypoglycemia
Treatment for Addisonian Crisis
-Isotonic fluids (normal saline or D5N5) + IV hydrocortisone or Dexamethasone
Cushing’s Syndrome is signs and symptoms related to
Cortisol excess
What are the four main causes of Cushing’s Disease
- Long-term high-dose glucocorticoid therapy (MC exogenous cause)
- Pituitary gland ACTH overproduction (MC endogenous cause)
- Adrenal tumor (Adenoma)
- Ectopic ACTH producing tumor (Small cell lung cancer)
Symptoms of Cushing’s Disease
- Weight gain, proximal muscle weakness
- Central obesity
- Moon facies
- buffalo hump
- Supraclavicular fat pads
- Thin extremities
- Striae
- Acanthosis Nigricans
- Hypertension
What are the screening test options for Cushing’s?
- 24 hour urinary free cortisol (most specific)
- Nightime salivary cortisol
- Low dose overnight Dexamethasone suppression test
To differentiate Cushing’s from other causes, what is the diagnostic that is done?
Baseline ACTH + High-dose dexamethasone suppression test
suppression of cortisol with high dose
Treatment for Cushing’s
- Corticosteroid use: gradual taper
- Cushing Disease: Transsphenoidal Resection
