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Endocrine 2 > Patho - adrenal gland > Flashcards

Patho - adrenal gland Flashcards

1
Q

adrenal medulla secretes:

A
  • epinephrine

- norepinephrine

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2
Q

adrenal cortex secretes:

A
  • mineralocorticoids

- glucocorticoids

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3
Q

where is the short term stress response from?

A
  • adrenal medulla

- epi and norepi

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4
Q

short term stress response

A
  • increase in blood glucose
  • increased BP
  • increased breathing rate
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5
Q

where is the long term stress response from?

A
  • adrenal cortex

- mineral and glucocorticoids

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6
Q

long-term stress response effects of mineralocorticoids

A
  • retention of Na and water by kidneys

- increased blood volume and BP

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7
Q

long-term stress response effects of glucocorticoids

A
  • increased blood glucose

- immune system suppression

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8
Q

adrenal cortex: steroid hormone production

-flow from cholesterol to aldosterone

A

cholesterol –> progesterone – (21-hydroxylase) –> corticosterone –> aldosterone

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9
Q

all end points of cholesterol from the adrenal cortex

A
  • aldosterone
  • cortisol
  • estradiol
  • DHT

*review this whole chart, he said to know it

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10
Q

adrenal cortex

A
  • 3 zones

- corticosteroid hormones are synthesized from cholesterol by cytochrom P450 enzymes

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11
Q

zona glomerulosa

A

aldosterone causes K wasting and Na reabsorption in the distal nephron of the kidney

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12
Q

zona fasciculata

A
  • cortisol production under influence of ACTH from the pituitary
  • circadian rhythm: high levels in morning and very little secreted at night
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13
Q

zona retiucularis

A
  • adrenal androgens are synthesized
  • DHEA and SHEAS
  • under the influence of ACTH
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14
Q

what is the key in the steps that occur in the adrenal medulla?

A

tyrosine metabolism

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15
Q

an increase of production of adrenal medulla catecholamines causes what?

A

pheochromocytoma

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16
Q

underproduction of adrenal medulla catacholamines causes what?

A

-not many problems like an increase does b/c there are plenty of catecholamines produced by the SNS

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17
Q

adrenal hormone excess =

A

cushing’s

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18
Q

MC cause of Cushings

A
  • taking exogenous steroids w/ glucocorticoid activity

- 5 mg/day of prednisone is unlikely to cause suppression but higher doses for 3 weeks or more can

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19
Q

difference b/w cushing’s disease and cushing’s syndrome

A
  • disease: overproduction of ACTH from the pituitary gland which stimulates the adrenal cortex to make corticosteroid
  • syndrome: excess from any other source (exogenous steroids)
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20
Q

physical findings of cushing’s

A
  • centripetal obesity
  • facial plethora
  • supraclavicular fat pads
  • wide violaceous striae
  • buffalo hump
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21
Q

a physical finding differentiation between cushing disease and syndrome

A

hyperpigmentation usually means it’s coming from the pituitary (cushing’s DISEASE)

22
Q

ACTH dependent vs. independent Cushing’s syndrome

A
  • dependent: (aka disease) caused by pituitary adenoma; 2/3 of cases
  • independent: caused by hyperplasia of the adrenal gland or adrenal adenoma
23
Q

w/u of cushing’s

A
  1. clinically suspected
  2. exclude exogenous glucocorticoids
  3. initial testing: 24 hr. UFC; LN salivary cortisol
    - if nl, Cushing is unlikely
    - if abnl: exclude physiologic hypercortisolism
  4. if physiologic is excluded, do additional testing
24
Q

important note on diagnostic testing of the pitutary/adrenal glands

A
  • biochemical testing first!!

- b/c there are common findings of non-functioning adenomas in both glands

25
Q

initial cushings testing

A
  • low dose dexamethasone suppression test
  • 24-hr urine free cortisol
  • late night salivary cortisol
26
Q

steps to take after cushing’s has been established

A
  • further testing to determine if it’s ACTH dependent or independent
  • referral to endo
27
Q

tx for CS if caused by pituitary tumor

A

surgery

28
Q

tx for CS if caused by adrenal adenoma

A

surgery

29
Q

tx of CS if caused by hyperplasia

A

-refer to endo

30
Q

adrenal insufficiency

A
  • may be d/t failure of the adrenal glands (primary)
  • or maybe inadequate secretion of cortisol form adrenals d/t other causes: critical illness (story of little baby)
  • or pituitary ACTH deficiency (secondary)
31
Q

sx of cortisol deficiency

A
  • fatigue
  • weakness
  • low grade fever
  • weight loss
  • anorexia
  • n/v
  • abdominal pain
  • arthralgia
  • myalgia
32
Q

signs of cortisol deficiency

A
  • hyperpigmentation

- decrease in BP

33
Q

lab finding of cortisol deficiency

A
  • decreased serum cortisol
  • increased ACTH
  • decreased Na and glucose
34
Q

sx of aldosterone deficiency

A
  • salt craving

- dizziness

35
Q

signs of aldosterone deficiency

A
  • orthostasis

- hypotension

36
Q

lab findings of aldosterone deficiency

A
  • increased PRA
  • increased K
  • decreased Na
37
Q

S/S of DHEAS deficiency

A

-reduced libido
-decreased axillary or pubic hair
(in women only)

38
Q

MC cause of primary adrenal failure

A

autoimmune adrenalitis

-antibodies to 21-hydroxylase

39
Q

diagnosis of primary adrenal failure

A
  • based on low serum cortisol levels

- most will present w/ hypotension, hyponatremia, hyperkalemia

40
Q

lab cortisol values in primary adrenal failure

A
  • early morning cortisol of <3ug/dl consistent w/ cortisol deficiency
  • > 15 excludes this diagnosis
41
Q

what to do if cortisol testing = 5-14 ug/dl

A

stimulation testing w/ synthetic ACTH

42
Q

how to differentiate primary vs secondary adrenal insufficiency

A

measure 8am plasma ACTH

43
Q

potential effects of primary adrenal insufficiency

A

Fatal!! this is why you have to pay attention of mineralocorticoid and glucocorticoid effect and strength of drugs

44
Q

steroid drug strengths

A
  • hydrocortisone: 1
  • prednisone: 4
  • prednisolone: 4
  • methylprednisolone: 5
  • triamcinolone: 5
  • dexamethasone: 25
  • bethamethasone: 25
  • cortivazol: 50
45
Q

adrenal crisis

A
  • adrenal fxn during critical illness:
  • pts who have been on cortisol replacement tx may need emergent dose of hydrocortisone when they become ill
  • pts who have been on steroids daily (COPD, arthitis, etc) will need a stress dose when acutely ill b/c they pituitary is suppressed
46
Q

primary aldosteronism

A
  • autonomous secretion of aldosterone
  • usually adrenal adenoma
  • in 10% of pts w/ HTN
47
Q

how do pts w/ primary aldosteronism usually present?

A

with hypokalemia and metabolic alkalosis

48
Q

what to do when primary aldosteronism has been established

A
  • CT to determine if there is an adenoma, hyperplasia, or carcinoma
  • renal vein renin then localize the source
49
Q

tx of primary aldosteronism

A
  • mineralocorticoid antagonsits (spironolactone)

- surgery

50
Q

pheochromocytom

A
  • tumor of the adrenal medulla secreting catecholamines (epi, norepi, dopamine)
  • most cause intermittent or sustained HTN
  • 1/3 occur w/ MEN-2
51
Q

best screening test for pheo

A

plasma free metanephrine

Endocrine 2 (15 decks)

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