L11: Adrenal Gland Disorders Flashcards
Revise Introduction from notes
First 2 Pages
Def of Cushing Syndrome
- A diverse symptom complex resulting from excess steroid hormone production by the adrenal cortex (endogenous) or to sustained administration of
glucocorticoids (exogenous)
what is Cushing Disease?
refers to → over secretion of ACTH from a pituitary adenoma
Causes of Cushing Syndrome
Causes of ACTH independent Cushing
- Overproduction of glucocorticoids may be due to an adrenal adenoma, adrenal carcinoma, or adrenal hyperplasia
what is the most common cause of Cushing Syndrome?
Exogenous glucocorticoid intake (Iatrogenic Cushing)
ACTH dependent Cushing by pituitary adenoma
Pituitary adenomas that secrete ACTH are derived from corticotroph cells in the anterior pituitary.
Obesity
- Cushing Syndrome
Generalized obesity in addition to centripetal (truncal) obesity
Moon facies
Buffalo hump
Cushing syndrome due to Ectopic Secretion
- Ectopic ACTH secretion is caused by small-cell lung tumors, carcinoid tumors
- Ectopic CRH secretion leading to increased ACTH secretion comprises a very rare group of cases of Cushing syndrome.
- Ectopic cortisol secretion from a case of ovarian carcinoma.
CP of Cushing Syndrome
Reproductive dysfunction
- Cushing Syndrome
Gonadal dysfunction with menstrual irregularity in females and loss of libido in both sexes
Hirsutism
Acne
Psychiatric abnormalities
- Cushing Syndrome
- Agitated depression
- Overt Psychosis
Bone
- Cushing Syndrome
Generalized osteoporos
Skin
- Cushing Syndrome
what causes increased skin pigmentation in Cushing Syndrome?
Increased skin pigmentation d2 overstimulation of melanocyte receptors by ACTH (only in ACTH dependent Cushing)
Muscle
- Cushing Syndrome
Myopathy
CVS
- Cushing Syndrome
- Hypertension
- Together with other metabolic derangement, as diabetes, may lead to increased mortality
Infection
- Cushing Syndrome
Fungal infections
Reactivation of TB
Wound infection and impaired healing
Investigations for Cushing Syndrome
Lab:
- Confirmation of hypercortisolism
- Differentiation of Cushing Syndrome
- In addition to others
Rad:
- Pituitary MRI with contrast
- Abdominal (Suprarenal) CT
- Chest X-Ray or CT
Eye
- Cushing Syndrome
Cataract
Raised intra ocular pressure
Exophthalmos because of increased retro orbital fat
Metabolic & Endocrine
- Cushing Syndrome
Impaired glucose tolerance or Diabetes Mellitus
Hypokalemic alkalosis
Hypogonadotropic Hypogonadism (reversible)
Water retention
Confirmation of hypercortisolism
- Cushing Syndrome
Rad Dx of Cushing Syndrome
Pituitary MRI with contrast : For pituitary adenoma
Abdominal (Suprarenal) CT : For adrenal causes
Chest X-Ray or CT : For ectopic Cushing
Diffrentiation of Cushing Syndrome
- Cushing Syndrome
IPSS
- Cushing Syndrome
TTT of Cushing Syndrome
Medical TTT of Cushing Syndrome
Surgical TTT of Cushing Syndrome
Irradiation therapy of Cushing Syndrome
- Irradiation of the pituitary could be reverted to when Trans-sphenoidal surgery is not successful or not possible.
- Late-onset adverse effects include hypopituitarism
Post-Operative Managment of Cushing Syndrome
Clearly, if both adrenals are removed, replacement with prednisolone is a lifelong treatmen
Nelson’s Syndrome
Causes of Pseudo-Cushing Syndrome
Def of Pseudo-Cushing Syndrome
Group of reversible disorders with subtle symptoms and signs of Cushing’s syndrome and hypercortisolism with defective response to dexamethasone suppression tests.
Def of Cyclical Cushing Syndrome
These patients require frequent monitoring with urine free cortisol or late-night salivary cortisol to establish the diagnosis, as cycle length varies from days to months.
- Cyclical Cushing Syndrome
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Inadequate cortisol in times of stress can lead to ……….
hypotension, shock, and hypoglycemia
……… deficiency typically leads to renal wasting of sodium, retention of potassium, and reduced intravascular volume.
Mineralocorticoid
Types of Suprarenal Failure (Adrenal Insufficiency)
what is addison’s disease?
- Is an uncommon disorder that occurs when body doesn’t produce enough of certain hormones.
- In Addison’s disease, adrenal glands produce too little cortisol and too little aldosterone
Def of Addison’s disease
- Is an uncommon disorder that occurs when body doesn’t produce enough of certain hormones.
- In Addison’s disease, adrenal glands produce too little cortisol and too little aldosterone
Causes of Addison’s disease
What is the most common cause of Addison’s disease in developed countries?
Autoimmune disease is the most common cause in developed countries
(90%)
Symsptoms of Addison’s disease
What is the most common cause of Addison’s disease in developing countries?
Tuberculosis (<10%) most common cause in developing countries
DDx of hyperpigmentation
Dx of Addison’s disease
Blood tests in Dx of Addison’s disease
ACTH stimulation test in Addison’s disease
Hx in Dx of Addison’s disease
Dark patches on skin might be a clue to consider testing for Addison’s disease
X-Rays in Dx of Addison’s disease
Calcium deposits on the adrenal glands
TTT of Addison’s disease
CT in Dx of Addison’s disease
Adrenals and/or pituitary gland.
Difference between 1ry & 2ry Adrenal insufficiency
Causes of Secondary Adrenal Insufficiency
Causes of Acute Hypoadrenalism (Addisonian Crisis)
CP of Acute Hypoadrenalism (Addisonian Crisis)
INVx for Acute Hypoadrenalism (Addisonian Crisis)
Plasma cortisol < 5 mcgm
Hypoglycemia
Hyponatremia
Hyperkalemia
DDx of Acute Hypoadrenalism (Addisonian Crisis)
Hypotension resistant to vasopressor agents
Medical cause of acute abdomen
PUO ( pyrexia of unknown origin )
D.D of underlying etiology
Read Power Questions from notes
pages 18 & 19
TTT of Acute Hypoadrenalism (Addisonian Crisis)
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