Krafts: Adrenal Pathology Flashcards by Sarah Carlson

What does cortisol do?

BBIIG:

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

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What is Cushing Syndrome?

TOO MUCH CORTISOL

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

Cushing Syndrome

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What is the charateristic habitus associated with Cushing Syndrome?

Moon Facies= gain weight in face

Buffalo hump

Trunkal obesity

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How do you dx Cushing Syndrome?

24-hour URINE free cortisol

Loss of normal diurnal cortisol secretion

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

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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What is the MC cause of Cushing Syndrome?

Iatrogenic CS

Steroid use>
hypoplastic adrenal cortices

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What labs can be used to dx Iatrogenic CS?

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

decreased ACTH

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What labs are indicative of pituitary cushing sndrome?

increased cortisol (Dex suppresses)
increased ACTH

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What happens to the adrenal cortex in Pituitary CS?

Hyperplastic adrenal cortices

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What lab tests are indicative of adrenal CS?

Increased cortisol (no suppression by Dex)

Decreased ACTH (too much cortisol)

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

Adenoma, hyperplasia, carcinoma

Hypoplastic or hyperplastic adrenal cortices

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What is paraneoplastic CS?

Cancer makes something that acts like ACTH

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What labs are indicative of Paraneoplastic CS?

increased cortisol (no suppression)
Increased "fake" ACTH

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What can cause paraneoplastic CS?

Small cell lung carcinoma

hyperplastic adrenal cortices

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

Iatrogenic

Pituitary adenoma

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What is hyperaldosteornism?

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

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What is primary hyperaldosteronism?

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

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What are sxs of primary HyperA?

Hypertension (hypernatremia)

Weakness/fatigue/psychosis (hypokalemia)

What lab findings are associated with primary hyperA?

Elevated aldosterone>
Low renin
Hypernatremia
Hypokalemia

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

What causes secondary hyper A?

Something OUTSIDE the adrenals

Decreased renal blood flow> Increased renin> increased aldosterone

Congestive heart failure
Renin-producing tumors

What lab finding is indicative of secondary hyperA?

high renin

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

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

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

Adrenocortical Carcinoma
RARE
Necrotic, “ugly”, tumor

Palpate abdominal mass

BAD prognosis

What is the MC cause of CAH?

21 hydroxylase def

A block in 21 hydroxylase affects production of what steroids?

Decreased cortisol and aldosterone (hypoTN, hypoNa) | Increased sex steroids (virilization)

How does CAH appear histologically?

Increased zona reticularis cells

What is Addison disease?

Primary chronic adrenial insufficiency

What causes PCAI?

Autoimmune attacks adrenal cortices> | too little cortisol/mineralcorticoids

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

primary chronic adrenal insufficiency

What causes skin hyperpigmentation?

POMC is a precursor that makes ACTH and melanocyte stimulating hormone

How do you tx Addison disease acutely? Chronically?

IV Na, hydrocortisone, dextrose Cortisol and daily prednisone for life

What is primary acute adrenal insufficiency?

adrenals suddenly aren't releasing what they should

What causes primary acute adrenal insufficiency?

Addisonian crisis Rapid steroid withdrawal Massive adrenal hemorrhage

What is Waterhouse-Friederichsen Syndrome?

``` Infant/young child> Bacterial infection (N. meningitidis)> Hypotension, shock DIC> Massive, bilateral adrenal hemorrhage ``` Rapidly progressive Neisseria (meningitis + skin rash)

What is secondary adrenal insufficiency?

decreased ACTH> | decreased adrenal products

What causes secondary adrenal insufficiency?

Pituitary or hypothalamic insufficiency | Tumor, infection, radiation, infarction

What are clinical features of secondary adrenal insufficiency?

Symptoms of decreased cortisol and decreased sex steroids Mineralocorticoids NORMAL (renin axis is intact) No hyperpigmentation

What is a pheochromocytoma?

Neoplasm of catecholamine-producing cells RARE cause of hypertension! Urine: catecholamines, VMA and metanephrines (brkdwn products of catecholamines)

What is the 10% tumor?

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

What are the 6 Ps of pheochromocytoma?

``` Pressure (increased blood pressure) Pain (headache) Perspiration Palpitations (tachycardia) Pallor Paroxysms (episodes) ```

What is seen histologically with pheochromocytoma?

zellballen (balls of cells)

What is a Neuroblastoma?

Tumor derived from NCC | relatively COMMON in childhood

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

``` 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 ```

Homer-wright rosettes are specific for what tumor?

Neuroblastoma

Flexner Wintersteiner rosettes are specific for what tumor?

retinoblastoma

True ependymal rosettes are specific for what tumor?

ependymoma