Lubitz Adrenal Endocrinology Flashcards
Synthetic cortisol adequately detect adrenal deficiency, but why can’t it distinguish between primary and central? (Give Two answers)
- Primary means nonresponsive kidney
- Secondary results in a shriveled adrenal gland.
Zona Glomerulosa makes _____ hormones
Mineralocorticoid
Parathyroid hyperplasia*, medullary thyroid carcinoma, and Pheochromocytoma are all associated with MEN___
2A
With respect to secondary adrenal insufficiency, how does it differ from primary?
Intact RAAS for Secondary!
In the face of hypercortisolism with LOW plasma ACTH, where is the disorder localized?
The Adrenal [ACTH-Independent]
adenoma, carcinoma, or hyperplasia
What syndrome is associated with Hyper-Aldosteronism?
Conn’s Syndrome
Excess cortisol can overwhelm the enzyme ______ resulting in more Mineralocorticoid (ALD).
11-Beta-HSD2
Cushing’s overwhelms the 11B-HSD2 enzyme and ends up making a lot of ______
Mineralocorticoids
The adrenal cortex arises from _____ of the embryo
Mesoderm
Zona reticularis makes ____ hormones products
Androgen
When testing for Cushing’s CRH will NOT cause ACTH or cortisol to boost if the disease is located in the ______
Ectopic Area
Pheochromocytomas are associated with MEN___ and ___ syndromes
2A, 2B
Adrenal meduula makes ____ hormones
Catecholamine
Pituitary Adenoma, Parathyroid Hyperplasia*, and Pancreatic Tumors are associated with MEN___
1
3 MEN 1 Syndromes?
“The first man really had to pee”
- Parathyroid Hyperplasia
- Pancreatic Tumor
- Pituitary Adenoma
Cushing’s Disease means the disorder is localized to the ______
Pituitary Gland
Most common cause of Primary Adrenal Insufficiency?
Auto-Immune
The adrenal medulla arises from ____ ___ of the embryo
Neural Crest
Aside from a 24 hr urinary test or late-night salivary cortisol test, how do you screen for Cushing’s Syndrome?
Overnight Dexamethasone
to test for hyper-secretion, inhibit
Easiest way to determine if there is a primary adrenal deficiency via a Physical Exam?
Hyperpigmentation
High ACTH levels linked to a-MSH
3 MEN 2A Syndromes?
“The Second man is wild “
- Parathyroid hyperplasia
- Medullary thyroid carcinoma
- Pheochromocytoma
How to treat psuedo-cushing’s?
Tx Underlying disease!
Look for the lab finding of hyper_____ if adrenal insufficiency is primary.
Kalemia
because all layers of kidney get hit
If a patient is not responding to catecholamines, then you should be clued in for _____ insufficency
Adrenal
Zona Fasciculata makes ____ hormones
Glucocorticoids
Mucosal neuromas and Marfanoid body, Medullary thyroid carcinoma and pheochromocytomas are associated with MEN____ disorders
2B
Hypercortisolism from Pituitary or Ectopic can be distinguished by a _____ Stimulation Test
CRH
(Tumor won’t respond), PIT will produce more ACTH and Cort
The most common tumor diagnosed <1 year of age is _______ associated with N-myc oncogene
Neuroblastoma
What are the 2 ACTH-Dependent syndromes?
- Cushing’s Disease (Pit)
2. Ectopic (Small Cell Lung Cancer)
In the face of hypercortisolism with HIGH plasma ACTH, where is the disorder localized?
Either Pituitary OR Ectopically (ACTH-Dependent)
What is the size of an Adrenocortical Carcinoma?
Large usually >4cm
What is Adrenal Waterhouse-Friderichsen Syndrome? (extra credit: what pathogen causes it commonly?)
Hemorrhaging of adrenal glands
usually Neisseria Meningitidis
Pseudo-Cushing’s is linked with ______ that result in excess release of CRH and the normal negative feedback doesn’t work. Doesn’t present as severe.
Stressors
over-exercise, eating disorders, pain, alcoholism, obesity, etc.
When testing for Cushing’s CRH will cause ACTH and Cortisol to boost if the disease is located in the ______
Pituitary
Parathyroid hyperplasia appears in both MEN____ and ____ disorders
- 1
- 2A
Mucosoal neuromas and Marfanoid body identifies MEN2____ as opposed to the similar MEN 2____ which doesn’t have that.
2A, 2B
