Pathophysiology IV

Question 1

Primary Adrenalcortical Insuffiency

Answer 1

1) Autoimmune Adrenalitis - most common cause
2) TB
3) Amyloidosis
4) Hemochromatosis
5) Bilateral Adrenalectomy
6) Adrenal Vein Thrombosis
7) Adrenal Artery Embolus
8) Metastatic Carcinoma

Question 2

Secondary Adrenalcortical Insuffiency

Answer 2

1) Corticosteroid Administration
2) Hypopituitarism (postpartum necrosis, chromophobe adenoma, hypophysectomy)
3) Optic Glimas
4) Craniopharyngiomas
5) Basal Meningitis
6) Stalk Section
7) Tumors of 3rd Vent
8) Encephalitis
9) Trauma
10) Corticosteroid Administration

Question 3

Symptoms of Adrenal Insufficiency

Answer 3

1) weakness
2) pigmentation of skin and muccus membranes
3) weight loss
4) hypotension
5) anorexia, nausea, vomiting
6) salt craving
7) hypoglycemic episodes - children more (if fasting higher risk, glycogen release from liver, gluconeogenesis) aa alanine
8) Syncopal Episodes
9) Vitiligo

Question 4

Symptoms of Acute Adrenal Insufficiency

Answer 4

1) hypotension
2) nausea and vomiting
3) collapse
4) hyperthermia
5) hypoglycemia
6) hyponatremia and hyperkalemia

Question 5

Causes of Cushings Syndrome

Answer 5

ACTH dep
1) Cushings Disease 68%
2) Ectopic ACTH syndrome
3) Ectopic CRH syndrome
ACTH indep
1) adrenal adenoma
2) adrenal carcinoma
3) micronoudlar hyperplasia
4) macronoudlar hyperplasia
Pseudo-Cushings
1) major depression
2) alcoholism

Question 6

Biochemical Tests for Cushing’s

Answer 6

• circadian rhythm of plasma cortisol
• low-dose dexamethasone suppression
• 24 hr. urinary free cortisol
• salivary cortisol determination

Question 7

Low-dose dexamethasone suppression test

Answer 7

-separate patients with Cushing’s syndrome of ANY cause from those without it

Question 8

High-dose Dexamethasone Suppression

Answer 8

• 2 day 2mg every 6 hr measure after 2 days
• overnight 8mg at 11PM measure plasma at 8am
• distinguish patients with Cushing’s syndrome of ANY cause from those without it

Question 9

What 3 tests tell if more than 1/2 patients have Cushings Disease?

Answer 9

1) 24 hr urine free cortisol
2) measurement of plasma cortisol and ACTH
3) high-does dex suppression test