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Endo/Repro: Week 1 > Krafts: Adrenal Pathology > Flashcards

Krafts: Adrenal Pathology Flashcards

1
Q

What does cortisol do?

A

BBIIG:

Maintains BLOOD pressure 
Breaks down BONE
Suppresses INFLAMMATION
Suppresses IMMUNE system
Stimulates GLUCONEOGENESIS
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2
Q

What is Cushing Syndrome?

A

TOO MUCH CORTISOL

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3
Q

If a pt presents with HTN, weight gain in a characteristic pattern, frequent infections and mental changes you should suspect…

A

Cushing Syndrome

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4
Q

What is the charateristic habitus associated with Cushing Syndrome?

A

Moon Facies= gain weight in face

Buffalo hump

Trunkal obesity

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5
Q

How do you dx Cushing Syndrome?

A

24-hour URINE free cortisol

Loss of normal diurnal cortisol secretion

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6
Q

What labs can you do to find the cause of Cushing Syndrome?

A

ACTH level
Dexamethasone suppression test> give pt steroid that is like cortisol to see if you can get ACTH level to go down (you should be able to suppress ACTH level)

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7
Q

What is the MC cause of Cushing Syndrome?

A

Iatrogenic CS

Steroid use>
hypoplastic adrenal cortices

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8
Q

What labs can be used to dx Iatrogenic CS?

A

Increased cortisol (no suppression–pt’s drug is acting as cortisol)

decreased ACTH

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9
Q

What labs are indicative of pituitary cushing sndrome?

A 
increased cortisol (Dex suppresses)
increased ACTH
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10
Q

What happens to the adrenal cortex in Pituitary CS?

A

Hyperplastic adrenal cortices

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11
Q

What lab tests are indicative of adrenal CS?

A

Increased cortisol (no suppression by Dex)

Decreased ACTH (too much cortisol)

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12
Q

What is seen in the adrenal cortex in a pt with Adrenal CS?

A

Adenoma, hyperplasia, carcinoma

Hypoplastic or hyperplastic adrenal cortices

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13
Q

What is paraneoplastic CS?

A

Cancer makes something that acts like ACTH

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14
Q

What labs are indicative of Paraneoplastic CS?

A 
increased cortisol (no suppression)
Increased "fake" ACTH
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15
Q

What can cause paraneoplastic CS?

A

Small cell lung carcinoma

hyperplastic adrenal cortices

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16
Q

What is the MC CS? What is the MC endogenous cause?

A

Iatrogenic

Pituitary adenoma

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17
Q

What is hyperaldosteornism?

A

Increased aldosterone>
increased Na/decreased K>
HTN/hypokalemia

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18
Q

What is primary hyperaldosteronism?

A 
Increased aldosterone> decreased renin
Cortical adenoma (Conn syndrome) 
Cortical hyperplasia
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19
Q

What are sxs of primary HyperA?

A

Hypertension (hypernatremia)

Weakness/fatigue/psychosis (hypokalemia)

20
Q

What lab findings are associated with primary hyperA?

A

Elevated aldosterone>
Low renin
Hypernatremia
Hypokalemia

Metabolic alkalosis (loss of H+ along with K+)

21
Q

What causes secondary hyper A?

A

Something OUTSIDE the adrenals

Decreased renal blood flow> Increased renin> increased aldosterone

  • Congestive heart failure
  • Renin-producing tumors
22
Q

What lab finding is indicative of secondary hyperA?

A

high renin

23
Q

What are causes of virilization (take on secondary sex characteristics of opp sex)?

A

Primary gonadal disorders
Primary adrenal disorders
-adrenocortical neoplasms
-congenital adrenal hyperplasia

24
Q

A pt presents w/ SUDDEN virilization. What do you suspect?

A

Adrenocortical Carcinoma
RARE
Necrotic, “ugly”, tumor

Palpate abdominal mass

BAD prognosis

25
Q

What is the MC cause of CAH?

A

21 hydroxylase def

26
Q

A block in 21 hydroxylase affects production of what steroids?

A

Decreased cortisol and aldosterone (hypoTN, hypoNa)

Increased sex steroids (virilization)

27
Q

How does CAH appear histologically?

A

Increased zona reticularis cells

28
Q

What is Addison disease?

A

Primary chronic adrenial insufficiency

29
Q

What causes PCAI?

A

Autoimmune attacks adrenal cortices>

too little cortisol/mineralcorticoids

30
Q

A pt presents w/ weakness, fatigue, GI complaints, hypoTN and SKIN HYPERPIGMENTATION.

Dx?

A

primary chronic adrenal insufficiency

31
Q

What causes skin hyperpigmentation?

A

POMC is a precursor that makes ACTH and melanocyte stimulating hormone

32
Q

How do you tx Addison disease acutely? Chronically?

A

IV Na, hydrocortisone, dextrose

Cortisol and daily prednisone for life

33
Q

What is primary acute adrenal insufficiency?

A

adrenals suddenly aren’t releasing what they should

34
Q

What causes primary acute adrenal insufficiency?

A

Addisonian crisis
Rapid steroid withdrawal
Massive adrenal hemorrhage

35
Q

What is Waterhouse-Friederichsen Syndrome?

A 
Infant/young child>
Bacterial infection (N. meningitidis)>
Hypotension, shock
DIC>
Massive, bilateral adrenal hemorrhage

Rapidly progressive

Neisseria (meningitis + skin rash)

36
Q

What is secondary adrenal insufficiency?

A

decreased ACTH>

decreased adrenal products

37
Q

What causes secondary adrenal insufficiency?

A

Pituitary or hypothalamic insufficiency

Tumor, infection, radiation, infarction

38
Q

What are clinical features of secondary adrenal insufficiency?

A

Symptoms of decreased cortisol and decreased sex steroids

Mineralocorticoids NORMAL (renin axis is intact)

No hyperpigmentation

39
Q

What is a pheochromocytoma?

A

Neoplasm of catecholamine-producing cells

RARE cause of hypertension!

Urine: catecholamines, VMA and metanephrines (brkdwn products of catecholamines)

40
Q

What is the 10% tumor?

A

pheocromocytoma

10% extra-adrenal (“paraganglioma”)
10% bilateral
10% (or more) familial
10% malignant
10% don’t have hypertension
41
Q

What are the 6 Ps of pheochromocytoma?

A 
Pressure (increased blood pressure)
Pain (headache)
Perspiration
Palpitations (tachycardia)
Pallor
Paroxysms (episodes)
42
Q

What is seen histologically with pheochromocytoma?

A

zellballen (balls of cells)

43
Q

What is a Neuroblastoma?

A

Tumor derived from NCC

relatively COMMON in childhood

44
Q

What can you look at to determine the prognosis in a pt with neuroblastoma?

A 
Children < 18 months
Lower stage tumors
Lower grade tumors
Hyperdiploid tumors (more than one set of chromosomes in tumor cells)
Fewer copies of N-myc
45
Q

Homer-wright rosettes are specific for what tumor?

A

Neuroblastoma

46
Q

Flexner Wintersteiner rosettes are specific for what tumor?

A

retinoblastoma

47
Q

True ependymal rosettes are specific for what tumor?

A

ependymoma

Endo/Repro: Week 1 (10 decks)

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