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Suprarenala Flashcards

1
Q

Ce secreta zona glomerulara?

A

Mineralocorticoizi —> Aldosteron (SRAA)

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2
Q

Ce secreta zona fasciculara?

A

Glucocorticoizi —> Cortizol

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3
Q

Ce secreta zona reticulara?

A

Androgeni —> Dehidrotestosteron (DHT)

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4
Q

Cum este ritmul circadian al Cortizolul?

A

Maxim dimineata ora 08:00

Min seara 23:00

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5
Q

Efectele ale Cortizolul: Hiperglicemiant!

A 
Ficat:
1. Gluconeogeneza --> Hiperglicemie
2. Rezistenta la Insulina -->Insulina cresc
==> Diabet zaharat Secundar
3. Dislipidemie

Creier: 
1. Psihoze/manii 
Os:
1. Osteoporoza secundara (Apoptoza osteoblastelor/accelar remod osoase)
CV:
1. HTA secundara (ATgen+ Retentie)
SI:
1. Imunosupresie
Renal: 
1. Bloc alpha1-hidroxilaza (Vit D) ---> Calciurie
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6
Q

Deficit de 21-hidroxilaza provoaca:

A
  1. Hiperplazia adrenala congenitala
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7
Q

Deficit de 21-hidroxilaza cum arata paraclinic:

A
  1. Deficit de Aldosteron
  2. Deficit de Cortizol
  3. EXCES DE ANDROGENI
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8
Q

Deficit de 21-hidroxilaza cum arata paraclinic:

A
  1. Deficit de Aldosteron
  2. Deficit de Cortizol
  3. EXCES DE ANDROGENI
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9
Q

Ce stimuleaza ACTH?

A
  1. Glucocorticoizi ( Cortizol)

2. Androgeni (DHT)

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10
Q

De unde este cortizolul excretat?

A

Cortizolul este excretat la niv urinar sub forma cortizol liber urinar cea ce putem sa masuram.

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11
Q

Ce moment important este un stres asupra organismului?

A

HIPOGLICEMIA

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12
Q

Care sunt cele 2 hormoni afectat de Hipoglicemia?

A
  1. GH

2. ACTH

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13
Q

Ce evenimente stresante poate provoca eliberarii de ACTH?

A
  1. Hipoglicemia
  2. Stres major
  3. Febra
  4. Dereglarea ritmul circadian
  5. Probleme psihice
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14
Q

In viata fetala ce rol prezinta Glucocorticoizi?

A

Dezvoltarea pulmonara prin secretie de Sulfactantul

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15
Q

Ce este sd Cushing?

A

Orice exces de Glucocorticoizi indiferent de sursa.

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16
Q

care sunt sd Cushing ACTH dependent:

A
  1. Adenom hipofizar secretant de ACTH (B.Cushing)

2. Secretie ectopica de ACTH

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17
Q

Care sunt sd Cushing ACTH independente:

A
  1. Adenom suprarenalian
  2. Neoplasm suprarenalian
  3. Hiperlazie nodulara (macro/micro)
  4. Iatrogen (Cea mai intalnita)
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18
Q

Care sunt semnele clinice in Sd Cushing?

A
  1. Facies in luna plina
  2. Ceafa de Bizon
  3. Hirusutism
  4. hiperemie
  5. Par subtire
  6. Echimoze
  7. Tegm subtire/Sort abd
  8. Vergeturi purpurii/vindecare greoaie
  9. Miopatie proximal/Osteoporoza
  10. Edeme
  11. Extremitati subtiri
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19
Q

Care sunt Riscurile asociate cu sd Cushing?

A
  1. HTA, sd Protrombotic (risc IMA/AVC)
  2. DZ secundar
  3. Osteoporoza
  4. Tulb psihice/cognitive
  5. Infectii/depresie imuna
  6. Hipogonadism, infertilitate.
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20
Q

Cauze de sd Pseudo-Cushing:

A
  1. Alcoolism
  2. Obezitate
  3. Depresie
    Stres functional crescut
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21
Q

Ce semne clinice apare in secretie ectopica de ACTH?

A
  1. hiperpigmentare
  2. scadere ponderala
  3. modificari metabolice accentuate
  4. alcaloza hipokaliemica
    - —> Screctie ft crecuta de ACTH (1000pg)
22
Q

Ce hormonii inhiba Glucocorticoizi?

A
  1. LH/FSH

2. GH (inhib cresterea, copii plinut + scunzi)

23
Q

Ce poate un Carcinom suprarenalian incurca?

A

Sindrom intens de virilizare +- Mineralocorticoizi

24
Q

Paraclinic sd Cushing:

A
  1. Limfocitopenie, eozinopenie
  2. Posibil diabet zaharat sau toleranta alterata la glucoza
  3. Dislipidemie
  4. Hipercalciurie
25
Q

Cum face screeening de hipercorticism?

A
  1. stergerea ritmul circadian al cortizolului plasmatic/salivar
  2. cortizolul liber urinar (> 100μg/24 ore)
  3. teste de supresie la doze mici de dexametazona (1 mg overnight sau 2 x 2)
    - –> 2x2 DXM (pseudo Cush vs Sd Cushing)
26
Q

Cum confirmam dgn de Hipercorticism?

A
  1. Dozarea ACTH
  2. Teste de supresie la DXM 8x2 (B.cushing vs ectopic)
    —> Se reduce partial ACTH la B.Cushing!!! (Ectopic nu)
  3. Investigatii imagistice pentru vizualizarea SR/hipofiza/plamanilor
    4.Cateterizarea bilaterala a sinusului pietros cu dozarea
    ACTH
27
Q

Care este tratamentul in B.Cushing?

A
  1. adenomectomie hipofizara transsfenoidala (de electie) sau suprarenalectomie bilaterala
28
Q

Care este tratamentul in Sd. Cushing

A
  1. extirparea tumorii suprarenaliene
29
Q

La un pacient cu B.Cushing la care s a efectuat suprarenalectomie bilaterala ce trebuie sa facem?

A
  1. Radioterapie hipofizara, pentru prevenirea sd.

Nelson!

30
Q

Ce medicamente putem sa folosim in sd Cushing:

A

Ketoconazol

  1. Mitotan: inhibitor enzimatic, adrenolitic, citostatic (carcinomul suprarenalian)
  2. In boala Cushing: pasireotid, cabergolina(Analog somatostatin)
31
Q

Insuficienta CSR primara (Boala Addison) cauze:

A
  1. Autoimune (Cele mai frecvente)
  2. Infectioase: TBC, CMV, fungi, HIV
  3. Hemoragie suprarenaliana
  4. Determinari secundare ale neoplasmelor
  5. Adrenoleucodistrofii
  6. Boli infiltrative: amiloidoza, hemocromatoza
  7. Hiperplazie adrenala congenitala
32
Q

Insuficienta corticosuprarenaliana secundara:

A
  1. Simptomatologia se instal treptat
  2. Semne si simptome ale ICSR
  3. Deficit de ACTH ( deficitGlucocorticoizi/androgeni)
    - –> Depigmentare
33
Q

Cum arata Cortizolul si ACTH la ICSR primara?

A

Cortizol mic, ACTH crescut (ft mult)

—> Hiperpigmentare!!!!

34
Q

Simptome in ICSR PRIMARA:

A
  1. Astenie
  2. Hiperpigmentare
  3. Scd ponderala
  4. Anorexia, ametelii, varsaturi
  5. HIPOTENSIUNE (<110/7)
  6. Pigm a mucoasei
  7. Lipsa pilozitati
    +- Vitiligo alte manifest Ai
35
Q

Paraclinic in ICSR Primara:

A
  1. HLG: anemie normocroma, normocitara, neutropenie, eozinofilie si limfocitoza relativa.
  2. Ionograma: hiponatremie, hiperpotasemie
  3. Uree, creatinina crescute prin deshidratare
  4. Hipoglicemie
36
Q

Teste hormonale in ICSR primara arata:

A
  1. Cortizol scazut, ACTH crescut

2. teste de stimulare la ACTH (Synacten) cu dozare de cortizol.

37
Q

Ce are un ICSR PRIMARA comparatie cu ICSR secundara?

A
  1. Insuf de sinteza de MINERALOCORTICOIZI (adica o afect a SRAA)
    - –> hiponatremie + Hiperpotasemie
  2. Semne de deshidratare
  3. hipoTensiune
38
Q

Corticoterapie:

A
  1. substitutiva Prednison 5 - 7,5 mg/zi
  2. antiinflamatoare Prednison 20 - 30 mg/zi
  3. imunosupresiva Prednison 1 mg/kg corp/zi
39
Q

In testul de stim ACTH (synacten) la ICSR primara ce rezultate avem?

A
  1. In ICSR primara nu creste Cortizolul!!!
40
Q

Tratamentul in ICSR PRIMARA:

A
  1. Substitutie pe linie gluco- si mineralocorticoida
    a) Hidrocortizon 20-30 mg/zi SAU
    b) Prednison5-7,5 mg/zi
    c) Fludrocortizon 0.05-0.1mg/zi
41
Q

Care este doza terapeutica de Prednison?

A

0.5-1mg/kgc/zi (20/30mg depinzand de situatie)

42
Q

Un pacient cu ICSR secundara trebuie tt substitutiva pt mineralocorticoizi?

A

NU, doar pe linia Glucocorticoida!!!

43
Q

Cand trebuie crescuta dozelor de substitutie la ICSR primara?

A

Cresterea dozelor in caz de infectii, interventii chirurgicale, varsaturi, diaree.
Doza trb crescută de 2-3x

44
Q

Cum urmarim tt substitutie la ICSR primara?

A

starea clinica, TA, ionograma, disparitia pigmentarii

45
Q

Insuficienta suprarenaliana acuta cand apare?

A
  1. Decompensarea ICSR cronice, primare sau secundare
  2. Intreruperea tratamentului corticoid
  3. Posthipofizectomie, suprarenalectomie bilat
  4. Apoplexie SR sau hipofizara
  5. Infectia cu meningococ
46
Q

Cum arata ICSR acuta clinic?

A
  1. hipotensiune marcata pana la soc
  2. varsaturi, greata
  3. febra
  4. dureri abdominale
47
Q

Care este managementul in ICSR acuta?

A
  1. echilibrare volemica Ser fiziologic, glucoza 5% 1,5-3L/ 24 h
  2. HHC460-600 mg pana la 1g/zi (doze mari!!!)
    —> Scz treptat dupa 2-3 zile.
  3. Tratamentul cauzei subiacente
    HHC—> Ef mineralocorticoid
48
Q

Cum arata un pac cu ICSR acuta paraclinic?

A
  1. Hiperpotasemie (Modificari ECG)
  2. Acidoza Metabolica
  3. Hipoglicemie
49
Q

Un pacient ICSR cu Tt substitutiv de Corticoterap trb un aport de sare cum?

A

Normal sarat

50
Q

ICSR acuta din cauza intreruperea corticoterapie se intampla in caz de? Cum se face întreruperea

A 
Tt corticoterap cu >7.5mg 
se face in trepte: 
1. 2.5mg primele 3-4zile
2. --> 1mg 2-4sapt
3. --> 1mg 2-4sapt
depinzand de durata tratamentului.
51
Q

Tratamentul in Sd. Cushing?

A
  1. Sindrom Cushing – extirparea tumorii
    suprarenaliene
  2. Tratament medicamentos:
    - Inhibitori ai sintezei de steroizi: ketoconazol, metyrapon, aminoglutetimid
    - Mitotan: inhibitor enzimatic, adrenolitic, citostatic (carcinomul suprarenalian)

Endocrine (12 decks)

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