HYHO - Newman #2 Flashcards
the HPA axis is a neurodendocrine system that controls reactions to _ and regulates _ (X5)
stress
digestion, immune system, mood, sexuality, energy
the _ _ _ of the HPA axis helps to regulate the concentration of hormones in the blood thus preventing over or under correction
negative feedback system
what zone of the adrenal cortex is responsible for
mineralocorticoids
glucorticoids
sex steroids
mineralocorticoids- glomerulosa
glucorticoids- fasiculata
sex steroids- reticularis
short term stress response involves stimulation of the _ via the _ fibers resulting in the release of _
adrenal medulla
via preganglionic sympathetic ribers
catecholamines
example of short term stress reponses
increased HR
increased BP
glycogen conversion to glucose in the liver and release into the blood
changes in blood flow patterns: decrease digestive system activity and reduced urine output
increased metabolic rate
long term stress response involves _ stimulation from the _, stimulation of the adrenal cortex by _ and release of _ and _
CRH stimulation from the anterior pituitary
stumulation of the adnreal cortex by ACTH
and release of mineralocorticoids and glucocorticoids
what are mineralocorticoids? what do they do?
aldosterone that leads to retention of sodium and water by the kidneys
increased blood volume and blood pressure
what are the glucocorticoids? what do they do?
cortisol they convert proteins and fats to glucose or energy
lead to an increased blood glucose, and suppresion of the immmune system
the renin angiotension aldosterone system is important in the regulation of _ , _ , and _ physiology
renal, cardiac, vascular
renin secretion from the kidney is stimulated by?
decreased renal perfusion (decreased blood to the kidney) or increase sympathetic anctivity
angiotensiongen is converted to angiotensin I by _
angiotensin I is converted to angiotension II by _
angiotensin II stimulates _ release from the _
renin
angiotension converting enzyme
aldosterone
from the adrenal cortex
always _ the genitalial of a newborn baby
examine
the most common cause of ambiguous genitalial in a genetically female infant is?
congenital adrenal hyperplasia causing virilization of the genitalia
can be life threatening and must be thought of if a baby presents with ambigious geneitalila
what is the common def. in congeital adrenal hyperplasia
what is there an increase of
21-hydroylase def (increased testosterone)
increase of the precursor - 17-OH progesterone
symptoms of congeital adrenal hyperplasia in a neonate
failure to thrive, recurrent vomiting, dehydration, hypotension, hyponatermia, hyperkalamia, shock
most common cause of congeital adrenal hyperplasia and the effects it has on aldosterone, cortisol, and androgens
cause: 21 hydroxylase def
aldosterone: low
cortisol: low
androgens: high
what are the mainstays of an infant in CRISIS due to congeital adrenal hyperplasia
hydrocortisone IV or IM (lifesaving)
fluids/glucose
management of hyperkalemia
what is the purpose of mandatory newboen screening
the detect potentially fatal or diabling conditions in the newborn before they develop a serious illness
what 3 adrenal gland defects are responsible for primary adrenal insufficiency (addisons disease)
adrenal dysfunction/destruction- most common (autoimmune)
adrenal dygenesis (x-linked congential adrenal HYPERplasia)
impaired steroidogensis
primary symptoms of primary adrenal insufficiency
all: fatigue, reduced stamina, weakness, anorexia, weight loss, skin hyperpigmentation
some: abdominal pain, MSK pain, psychiatric symptoms, salt cravings, low blood pressure, vomiting
what are the labs in a patient with adrenal insufficiency
wbc:
serum glucose:
serum sodium:
serum postassium:
wbc: low- neutropenia
serum glucose: low (low cortisol)
serum sodium: low (low aldosterone)
serum postassium: high(low aldosterone)
in primary adnreal insufficiency also known as _ _ there is _ 8 AM plasma cortisol accompanied simultaneously by signifigant elevation of plasma _
addisons disease
low
ACTH
what are the symptoms of acute adrenal crisis
dehyration, dissiness, rapid heart rate, confusion, fever, headache, abdominal pain
what are the lab findings for acute adrenal crisis
cortisol
blood sugar
serum sodium
serum potassium
ph
inadqeuate bump in _ level with a ACTH stimulation test
cortisol: low
blood sugar: low
serum sodium: low
serum potassium : high
ph: metabolic acidosis
inadqeuate bump in CORTISOL level with a ACTH stimulation test
how do you treat acute adrenal crisis
hydrocortisone (critical)
IV/glucose
fludrocortisone after hydrocortisone
treat hyperkalemia
lower than normal serum cortisole would typically result in _ serum ACTH if everything was working normally
increased/high
a lack of pituitary secretion of ACTH in response to a low serum cortisol indicated?
that the problem is higher than the adrenal gland itself: pituitary tumor, damage?
low serum ACTH in the setting of low serum CORTISOL is consistent with?
secondary adrenal insufficiency
signs of cushing syndrome
increased cortisol
obesity, truncal weight gain
moon face
buffalo hump
hirsutism
thirst.polyuria
hypertension
dark purple striae
mental symptoms
impaired wound healing
suceptibility to opportunisitc infections
elevated midnight cortisol levels are indicative of?
cushing syndrome
what is the best screening test for cushing syndrome
dexmathasone stimulation test
dexmethasone should suppress _ from the anterior pituitary
ACTH
explain the dexmethasone test
- low dose dexmathasone is given at night
- serum cortisol levels are drawn in the morning
- if serum cortisol is below a certain level then you can exclude cushing syndrome
- you compaire cortisol levels with ACTH levels before dexamathasone was given
is acth is low, and cortisol is not suppressed by high or low doses what is the disease
primary hypercortilism meaning that the problem is in the adrenal gland
if ACTH is super elevated and cortisol is not suppresed by high or low doses of dexamethasone then this means
there is ectopic acth
if ACTH is normal or midly elevated and cortisol is not suppressed by low but is suppresed by low doses what is this outcome
cushing disease (pituitary issue)
ectopic ACTH syndrome is often associated with?
small cell carcinoma of the lung
why are most patients with primary aldosteronism are hypertensive
excessive aldosterone production increases sodium retention which pulls water with it and increases the blood pressure
what are the signs of primary aldosteronism
hypertension, hypokalemia (muscle weakness, polyuria.plydipsia)
consider the diagnosis of primary aldosteronism if?
- treatment resistant hypertension
- severe hypertension
- early onset hypertension
- hypertension with adrenal mass
- low renin hypertension
- hypertension with a family history of early onset HTN or CVA
- 1st degree relative with aldosteroinism
primary aldosteronism has what 3 things
hypokalemia
metabolic alkalosis
low renin hypertension
what is conn syndrome
it was a unilateral aldosterone producing adrenal adenoma that caused HTN
but not it is just a way to state that someone has primary hyperaldosteronism (from the adrenal gland)- doesnt have to be an adenomatous cause
what is the location of a pheochromocytoma and what does it secrete
adrenal medulla
secretes catecholamines
where is a paraganglioma located and what does ti secrete
outside of the adrenal gland
can secrete nothing or secrete catecholamines
what are the symptoms of a pheochromocytoma and a paraaganglioma since they present similarily
paroxysmal (sudden)
pressure elevated (blood pressure)
pounding pain (headache)
perspiration
panic
palpitations
pallow (after the spell has subsided)
the 7 p’s
what is the most sensitive test for diagnosing secretory pheochromocytomas and paraganlgiomas
plasma fractionated free metanephrines
Von Hippel Linadu- disease type 2 is inherited in a _ (pattern) fashion, 20% of people will develop _ and patients will have _ _ hemangiomas, hemanigioblastomas of the _ and an increased risk for _ _ that transform into renal cell carcinoma
autosomal dominant
pheochromocytomas
retinal capullary
CNS
renal cysts
how should you treat pheochromocytomas?
alpha blockers first then beta blockers
(alpha first because unopposed alpha recetor stimulation can lead to an elevation of blood pressure)
adrenal gland incidentalomas are usually found on ?
abdominal CTs, MRI, done for other problems
most adrenal gland incidentalomas are _ (benign/malignant)
benign
if an adrenal gland is more that _ cm and is not a benign lesion, cyst or has hemorrhage it should be _
4cm
ressected
if a patient with an adrenal incidentaloma presents then there is required testing for?
cushing syndrome, hyperaldosteroinism, pheochromocytoma testing
MEN syndromes are caused by?
gene mutations and tend to run in families
