Primary Adrenocortical Insufficiency

Question 1

Where is Corticotropic Releasing Hormone (CRH) is excreted from?

Answer 1

Hypothalamus

Question 2

What does corticotropic releasing hormone do?

Answer 2

stimulates release of adrenocorticotropic hormone from the anterior pituitary

Question 3

What does ACTH do?

Answer 3

stimulates the release of aldosterone, cortisol and androgens

Question 4

What hormones are released by the adrenal cortex?

Answer 4

• mineralcorticoids (aldosterone)
• glucocorticoids (cortisol)
• androgen

Question 5

What does aldosterone do?

Answer 5

increases sodium and water retention to increase BP

Question 6

What do glucocorticoids do?

Answer 6

• immunosuppression (inc infections)
• anti-inflammatory effects
• weight gain
• insulin resistance
• skin thinning
• increases osteoclastic activity
• increases BP

Question 7

Primary adrenocortical insufficiency is also known as what?

Answer 7

Addison’s Disease

Question 8

Addison’s disease is characterized by deficiency of what?

Answer 8

• cortisol
• androgens
• aldosterone

Question 9

What are risk factors for the development of Addison’s disease?

Answer 9

• females
• sudden withdrawal of glucocorticoids
• stress
• trauma
• destruction or removal of the adrenal cortex
• sepsis
• tuberculosis

Question 10

What are the causes of Addison’s disease?

Answer 10

• autoimmune disease
• bilateral adrenal hemorrhage
• metastatic cancer
• infections of the adrenal glands (TB, Immunocompromised)
• genetic predisposition
• decreased levels of ACTH
• drugs

Question 11

What drugs can cause Addison’s disease?

Answer 11

• Mitotane
• Abiraterone Acetate
• etomidate
• Ketoconazole and fluconazole
• Ipilimumab

Question 12

What are chronic subjective/physical findings from Addison’s disease?

Answer 12

• Weakness/fatigue
• headache
• N/V
• ABD pain w/ diarrhea
• hyperpigmentation
• little to no axillary hair
• muscle and joint pain
• hypotension
• arthralgias
• weight loss

Question 13

Hyperpigmentation in Addison’s disease is relate to what?

Answer 13

excess ACTH

Question 14

What are acute subjective/physical findings have a patient in adrenal crisis?

Answer 14

• Shock or hypotension
• Marked, rapid worsening of chronic symptoms
• fever
• hypovolemia
• changes in LOC
• N/V
• weakness, lethargy
• abd, flank, back or chest pain

Question 15

9) What laboratory findings are present with primary adrenocortical insufficiency?

Answer 15

• hyponatremia
• hypoglycemia
• hyperkalemia
• elevated erythrocyte sedimentation rate
• neutropenia
• lymphocytosis
• eosinophil count >300/mcl
• plasma cortisol < 3 mcg/dlat 8:00 AM is diagnostic
• hypercalcemia
• elevated BUN
• metabolic acidosis
• serum DHEA levels < 1000ng/mL

Question 16

What diagnostic testing should be done to diagnose primary adrenal cortical insufficiency?

Answer 16

• CMP
• serum ACTH (high)
• Cosyntropin stimulation test
• serum DHEA level
• chest and abd X Rays
• CT of adrenal glands

Question 17

A patient with primary adrenal cortical insufficiency will have what results from the cosyntropin stimulation test?

Answer 17

there will be no rise in serum ACTH levels

Question 18

Elevated morning ACTH levels are indicative of which type of adrenal insufficiency?

Answer 18

Primary adrenal insufficiency

Question 19

Low levels of morning ACTH are indicative of what type of adrenal insufficiency?

Answer 19

Secondary adrenal insufficiency

Question 20

What drug is used in the treatment of Addison’s disease?

Answer 20

Hydrocortisone

Question 21

What should be done if adrenal cortical insufficiency is suspected?

Answer 21

collect cortisol levels

Question 22

Calcified adrenal gland seen on a CT are commonly seen in what condition?

Answer 22

Tuberculosis causes of adrenal cortical insufficiency

Question 23

Enlarged adrenal glands seen on a CT may be related to what conditions?

Answer 23

Metastatic or granulomatosis disease

Question 24

Small, noncalcified adrenal glands seen on a CT is indicative of what?

Answer 24

Autoimmune adrenal disease

Question 25

If a patient is receiving glucocorticoid treatment, what must be done prior to administering the cosyntropin stimulation test?

Answer 25

Discontinue hydrocortisone at least 8 hours prior to test