endocrine pathology

Question 1

Adrenal insufficiency diagnosis

Answer 1

1. Morning/random serum coritisol and ACTH
2. Stimulation tests:
   - ACTH Stimulation test
   - Metyrapone stimulation test ( blocks last step of cortisol synthesis (11-deoxycortisol to cortisol)

Normal response: decreased cortisol and compensatory increase in ACTH and 11-deoxycortisol.

Primary Adrenal insufficiency: ACTH is increased but 11-deoxycortisol remains low after test.

Secondary Adrenal insufficiency: ACTH and 11-deoxycortisil remain low after test.

Question 2

Primary adrenal insufficiency

• Cause
• Deficient Hormones
• symptoms
• Osmolarity
• Associated syndromes

Answer 2

• Gland dysfunction
• Deficiency or aldosterone and cortisol
• Hyperkalemia, hyperpigmentation
• Hypoosmotic volume contraction (hyponatremic)
• Autoimmune polyglandular syndrome and Waterhouse Frederichsen Syndrome

Question 3

Secondary Adrenal insufficiency

• Cause
• symptoms (note the symptoms that ARNT present vs primary.)

Answer 3

• Decreased pituitary ACTH production.
• Aldosterone synthesis is preserved
• Hyperkalemia and hyperpigmentation not seen.

Question 4

Most important difference between primary and secondary hyperaldosteronism

Answer 4

Aldosterone escape mechanism.
Primary Aldosteronism does not directly cause edema due to aldosterone escape.

Secondary hyperaldosteronism is associated with impaired aldosterone escape mechanism which worsens edema.

Question 5

Primary hyperaldosteronosm

• Causes
• Hormone changes

Answer 5

Causes:
Conns syndrome (adrenal adenoma)
Bilateral adrenal hyperplasia

Hormones: increased aldosterone, decreased renin