OME Adrenal Flashcards
Adrenal Layers
GFR= Glomerulosa- outer layer, aldosterone
Fasiculata- Cortisol
Reticularis- Testosterone (Salt, Sugar, Sex)
Medulla catacholamine
Cushing Syndrome and Causes
Excess Cortisol
Causes:
ACTH-Dep- Lung cancer (small cell) or Pituitary tumor
ACTH Independent- Ingesting excess steroids or primary tumor of adrenal gland producing excess cortisol.
Presentation of Cushing’s Syndrome
HTN, DM, Obese (not that much of a hint, but remember cortisol does opposite of insulin with glucose) Moon facies (Bad acne) Truncal obesity Buffalo Hump Purple Striae
Cushing’s Syndrome DX
Low (AC)THen High.
See chart
Addison’s Dz Causes
Most common in US cause: Autoimmune.
In World: TB
Also possible is Antiorior Pituitary
Addison’s Presentation
Acute:
Hypotension (no cortisol means no vasoconstriction/ Also no aldosterone possibly means no volume).
N/V
Coma
Chronic: Orthostatic
Hyperpigmentation (b/c increase ACTH)
Low Na, high K if no aldosterone.
Addison’s DX
See chart
Conn’s Syndrome Path
Path: Primary tumor-Conn’s
Renovascular HTN- FMD for young female
Arthrosclerosis for Old male
Conn’s Presentation
HTN + Hypo K
or
Secondary HTN= refractory after three or more BP meds
Conn’s DX
See chart
Pheochromocytoma Path and Presentation
Catecholamine secretion
5 P's Paroxysmal Pain (headache), Pressure (HTN), Palpitations (tachycardia) Perspiration
Pheochromocytoma DX
Plasma free catecholamine
or
24- hr urine metanephrines/ VMA
CT/MRI Abd
Adrenal Vein
Pheo TX
Alpha blockade FIRST
Beta Blockade Next
Resect.
Incidentaloma
Path: nothing, just found it on Asx scan or CT/MRI abd.
DX: r/o conn’s cushing’s, pheo by 24 hr urine
Tx: watch and wait if less than 4 cm or resect if greater than 4 cm or functioning.
