Sos- Adrenal Disorders Flashcards
____ glands are crucial for homeostasis
endocrine
what to be mindful of when removing R kidney
IVC (due to short suprarenal vein)
how adrenal medulla is connected to nervous system
innervated by sympathetics and chromaffin cells are stimulated by Ach that is released
location of adrenal glands
T12-L1 (retroperitoneal too)
zona glomerulosa regulated by
Ang II (RAAS)
zona fasciculata and reticularis regulated by what
CRH and ACTH
chromaffin cells of medulla are regulated by what
preganglionic sympathetic fibers
normally, ____ acts to block inflammation and maintain homeostasis in the body
cortisol
Autonomic NS is fast and overrides _____ in moments of fight or flight
endocrine
someone with HTN, obesity, advanced diabetes
overriding endocrine system to the point where it’s not functioning anymore
21-hydroxylase deficiency is the most common cause
congenital adrenal hyperplasia (bilateral)
Most common cause of ambiguous genitalia in female newborns
congenital adrenal hyperplasia
75% have salt wasting
Weight loss and dehydration
Adrenal crisis
Elevated 17oh progesterone 48 hrs
Skin pigmentation due to melanocyte stimulating hormone
congenital adrenal hyperplasia
what happens in congenital adrenal hyperplasia when the cause is 21-hydroxylase deficiency
decreased cortisol and aldosterone and increased androgens
Most common
Infants have salt wasting
Precocious puberty
XX virilization
21-hydroxylase deficiency
21-hydroxylase deficiency
why does K+ increase with 21-hydroxylase deficiency
b/c aldosterone (and cortisol) are decreased, so that will increase K+ in the serum
primary hypothalamic/pituitary disease associated with hypersecretion of ACTH
Cushing Disease
____disease results in ____ syndrome and also there can be many causes for the syndrome
Cushing
most common exogenous cause of Cushing Syndrome
(medications)/iatrogenic
most common endogenous cause of Cushing syndrome
pituitary adenoma (ACTH)
ACTH dependent endogenous cause of Cushing syndrome that is not pituitary adenoma
paraneoplastic
main cause of cushing syndrome that is ACTH independent
adrenal cortex adenoma
Presents with muscle weakness (cortisol metabolizes muscle), HTN, osteoporosis, immune suppression, moon facies truncal obesity and back fat accumulation
Cortisol Syndrome
exogenous corticosteroids causing Cushing syndrome
primary adrenal adenoma causing cushing syndrome
ACTH secreting pituitary adenoma causing Cushing syndrome
Paraneoplastic ACTH secretion causing Cushing syndrome
most common form of Cushing syndrome
Iatrogenic Cushing Syndrome
used to treat autoimmune and inflammatory diseases and causes iatrogenic cushing syndrome
glucocorticoids
Pituitary ACTH adenoma causing Cushing’s Syndrome
Secretion of ectopic ACTH by non-pituitary tumors accounts for 10% of cases of Cushing Syndrome
ectopic paraneoplastic cushing syndrome
Associated neoplasms:
Small cell carcinoma of the lung
Neuroendocrine tumors
Medullary carcinoma of the thyroid
paraneoplastic cushing syndrome
adrenal cushing syndrome caused by cortical adenoma
well circumscribed, cortical, yellow in color
Adrenal adenoma
decreased production of cortisol and aldosterone; rare
Develops slowly and when the patient has a stress (illness or trauma), symptoms worsen
Addison’s disease
adrenal insufficiency that worsens due to stress (illness or trauma)
Addison’s disease
Symptoms:
Hypoglycemia, hypotension, fatigue
Abdominal pain, nausea, diarrhea and vomiting
Salt craving
Muscle and joint pain
Weight loss
Can progress to a crisis state
Addison’s Disease
Young (30-50)
Not diagnosed at birth
Stress to body, and then it appears
Adrenal glands fail and the individuals cant cope with it and cant make cortisol or aldosterone (electrolytes out of whack)
Adrenal Crisis
Clinical presentation:
Unexplained hypoglycemia and fever
Dehydration, hypotension or shock out of proportion to current illness
Abdominal pain, nausea and vomiting with a history of weight loss
Hyponatremia, hyperkalemia, hypercalcemia
Adrenal Crisis
way too much aldosterone
treatment resistant HTN
affects kidneys, heart, blood vessels
Conn’s disease (primary aldosteronism)
2 adrenal medullary tumors
neuroblastoma
pheochromocytoma
Racoon eyes (cancer metastasized to behind the eyes) + mass in abdomen
neuroblastoma of adrenal medulla
Catch before 2 years—–80% survival
neural crest derived
increased levels of urinary catecholamines
Neuroblastoma
Homer-Wright rosettes
IHC + for NSE, synaptophysin, chromogranin
Neuroblastoma
arises from adrenal medulla or sympathetic chain ganglia
Neuroblastoma
Zellballen pattern (nests or balls of cells surrounded by connective tissue)
Pheochromocytoma
Rule of 10’s
10% malignant, bilateral, extra-adrenal, calcify, in kids
pheochromocytoma
IHC+ for NSE, synaptophysin, and chromogranin
Most common tumor in adults, but rare
pheochromocytoma
HTN that doesn’t respond to HTN meds
Mahogany brown (cortex still functioning) but medulla growing
pheochromocytoma
produces large amount of epinephrine
pheochromocytoma
Episodic hyperadrenergic symptoms, the 5 P’s:
Pressure, increased BP
Palpitations, heart tachycardia
Pain, headaches
Perspiration
Pallor
Pheochromocytoma
