Friday - Adrenal Path and MEN - Krafts Flashcards
Cushing syndrome is due to what?
Too much cortisol
Actions of Cortisol
blood pressure
breaks down bone
suppress inflammation and immune function
gluconeogenesis
bbiig
Sx of cushing’s syndrome
hypertension, weight gain - habitus (toro, moon face, buffalo hump) weakness infections mental changes
Labs for Cushing’s
24 hour cortisol
ACTH level - can be high or low, just shows cause
dexamethasone suppression test - give it and measure cortisol -
Pituitary Cushing syndrome happens how
Adenoma that makes ACTH –> cortisol
When is the dexamethasone test helpful?
figure out if it’s pituitary adenoma causing the cushings. dexamethasone at high doses with make the tumor stop secreting
adrenal tumor secreting cortisol wouldn’t respond
Cushing syndrome due to tumor. Didn’t respond to dexamethasone.
what two things could it be from? how do you distinguish between them?
Adrenal tumor or paraneoplastic (small cell lung carcinoma)
paraneoplastic has rise in ACTH, but it’s like a fake ACTH
common cause of hyperaldosteronism
cotical adenoma of the adrenals –> ald –> decrease renin
Symptoms of hyperaldoseronism
hypertension
weakness/fatigue
lab findings of primary hyperaldoseronism
increased aldosterone
decreased renin
hypernatremia
hypokalemia
Secondary hyperaldosteronism labs
due to?
increased renin and aldosterone
decreased blood flow from a renin making tumor
what is virilization
a girl that gets swoll and many characteristics like lots of hair.
due to too many androgens
Sudden virilization can be from what tumor
adrenocortical carcinoma
- bad prognosis
most common hydroxylase deficiency and labs
Cortisol, Aldosterone
Sex seteroids
21 hydroxylase
decreased cort and ald
increased sex steroids
name for primary chronic adrenal insufficiency
cause
symptoms
addison’s disease
autoimmune
weakness, hypotension and skin pigmentation
waterhouse friderichsen syndrome
It’s a primary adrenal insufficiency
neisseria –> adrenal hemorrhage –> hypotension, shock.
rapid
Secondary renal insufficiency due to:
decreased ACTH
- from pituitary insufficiency
- tumor, infection, radiation
Pheochromocytoma
cells make:
catecholamines
–> hypertension
Symptoms of pheochromocytoma
high BP headache sweating tachycardia paroxysmal
histo of pheochromocytoma
not much
large nuclei
“zellballen” - balls of tumor
neuroblastoma is from what
common in what pop
prognosis good if:
lab finding (first aid)
neural crest children younger than 18 mo fewer copies of n-myc increased dopamine breakdown product in urine (homovanillic acid)
histo of neuroblastoma
rosettes (homer-wright)
MEN1 also called:
where do you get tumors
Wermer syndrome parathyroid hyperplasia - stones pancreatic tumors - gastrinoma, insulinoma pituitary adenoma
MEN1 gene codes for what?
mutation does what
menin
turns gene off (tumor suppressor gene)
MEN2A tumors
medullary thyroid carcinoma
pheochromocytoma
parathyroid hyperplasia
MEN2A gene
what kind of receptor
mutation does what?
RET gene mutation
proto-oncogene
tyrosine kinase receptor
turns gene on
MEN2B manifestations not seen in 2A
oral
marfanoid looking
