Evaluation of Adrenal fxn

Question 1

Adrenal gland areas in order

GFR

Producing SSS

Primary regulatory control of ZG
ZF
ZR

Medulla

Answer 1

ZG, ZF, ZR

salt, sugar, sex

ZG- Renin/AT
ZF/ZR- ACTH/CRH

Pregang symp fibers

Question 2

patients to test

Aldo regulates

Hyperaldo leads to

measure aldo to renin ratio, high indicates

HypoAldo

Answer 2

suspected adrenal dz, incidental lesions

HTN, hypoK

hyperAldo

hypoTN, hyperK

Question 3

Cortisol excess sx F, S, D, E, Skin, temporal, menstrual, o, hypoK

Causes of cortisol excess (4)

Hypothalmus releases

AP

Adrenals, provides

first step w suspected hypercortisolims

Answer 3

Facial plethora, supraclavicular/dorsocervical fat pads, easy bruising, fragility, balding, abnorm, obesity

Iatrogenic, pituitary (ACTH), adrenal (Cortisol), Ectopic ACTH/CRH

CRH
ACTH
Cortisol, NF

confirm excess cortisol

Question 4

Dx test for hypercortisol

24hr urine free cortisol- measures ____ in 24hr period

low dose DM suppression- measures fasting plasma cortisol ____
normal level

Late night salivary cortisol- detects elevated cortisol levels in ___

Answer 4

circulating blood

following morning to observe suppression
<1.8

saliva bw 11/midnight

Question 5

low dose DM should have same effect as

normal individual will have

dz patient will have

to determine cause of elevation, check

normal/high indicate

low indicates

next step

Answer 5

cortisol, inhibitting CRH/ACTH

low cortisol

high cortisol

plasma ACTH

pituitary/ectopic ACTH

adrenal cause

imaging/surger

Question 6

if ACTH high, next test is

will suppress _____
next step

____ will not respond
think

Answer 6

high dose DM suppression

pituitary ACTH
imaging/surgery

ectopic source (No nfm)
lung cancer/carcinoid

Question 7

Primary acute adrenal crisis caused by

seen in N
P
W

Answer 7

infarct/hemorrhage

Neonates w adrenal hemorrhage
Post op pt w DIC
Waterhouse-Friderichsen syndrome (neisseria meningitidis)

Question 8

Primary Chronic AI (Addisons)

causes

secondary AI (Pituitary)

Tertiarty

addtl cause

Answer 8

AI (US) Tb (worldwide), metastatic/infiltrative dz, resection

Sheehan/s syndrome

hypothalamus

exogen steroids suppress pituitary/hypothalamus

Question 9

Features of AI

F, S, N/V, H w, W, M

look for hyperpigmentation in

Dx of cortisol def w

low AM cortsiol provides

Answer 9

fatigue, salt craving, NV, hyperpigmentation w ACTH excess, wl, muschel aches

knuckles, mucous membranes

ACTH stim test

clue

Question 10

Cosyntropin should inc

lack of response indicates

to determine cause, check

If ACTH high

if ACTH low/normal

Answer 10

cortisol

AI

8am plasma ACTH

adrenal dysfxn (primary)

central dysfxn (sec/tert)

Question 11

CAH sx caused by

typically due to ___ enzyme deficiency

others include

blocks formation of, inc

measure _____ helps indicate CAH

Answer 11

excess sex steroids

21 hydroxylase deficiency

CYP11/CYP17

17 hydroxyprogesterone (if high)

Question 12

sx typically involve

Classic salt wasting w

Virilizing syndrome

TX

Answer 12

complete blockage- no MC/GC

some MC/GC produced

replace GC/MC

Question 13

Medullary def not common bc

____ more noticeable

Pheo sx

PPPPP

Answer 13

redundacy of catechol around SNS

excess

HTN, rapid heartbeat, sweating, tremors, anxiety, pale face, SOB

Pressure (HBP), Pain (HA), Perspiration, Palpitations (tachy), Pallor

Question 14

Pheo dx

intial test

localize w

rule of 10s 
M
B
E
C
C

Answer 14

Normeta/Metanephrine in plsma/24 hr urine

imaging

10% malignant
bilateral
extra adrenal
calcify
children

Question 15

Tx pheo

first step

do not use ___ alone

possible genetic syndromes

Answer 15

removal

alpha blockade

BB (HTN crisis w unopposed alpha receptors)

MEN/NF1/vHL

Question 16

Incidentalomas

Rule out

Characteristics
\_\_\_ shape
C
\_\_\_invasion
L

benign has

Answer 16

cancer, fxning

irregular
calficications
local
large >4cm

opposite characteristics