Various Pathologies

Question 1

Cushings with Decreased ACTH

Answer 1

From exogenous steroids or primary adrenal adenoma/hyperplasia/carcinoma. Will not respond to Dexamethasone suppression test.

Question 2

Cushings with Inc ACTH

Answer 2

Cushings disease: pituitary adenoma secreting ACTH, secretion will be decreased with High dose Dexamethasone, secretion of ACTH will increase with CRH stimulation test

Cushings syndrome: ectopic ACTH secretion from paraneoplastic secretion, secretion will not be suppressed or increased with Dexamethasone or CRH tests (respectively).

Question 3

Adrenal insufficiency

Answer 3

Adrenals unable to generate enough glucocorticoids and/or mineralocorticoids for bodys needs.

Question 4

Primary Adrenal insufficiency

Answer 4

Primary: Deficiency of aldosterone and cortisol due to loss of gland function –> hypotension, hyperkalemia, metabolic acidosis, skin and mucosal hyperpigmentation (due to MSH, a byproduct of inc ACTH secretion). Acute is sudden due to massive hemorrhage. Chronic is Addisons due to adrenal atrophy or destruction by disease (TB, AI, mets)

Question 5

Secondary and Tertiary Adrenal insufficiency

Answer 5

Secondary: Decreased pituitary ACTH, no skin/mucosal hyperpigmentation, no hyperkalemia (aldosterone syn preserved)

Tertiary: Seen in pts w/chronic exogenous steroid use, precipitated by abrupt withdrawal leading to dec CRH (suppressed HPA axis).
Aldosterone synthesis unaffected.

Question 6

Hyperaldosteronism

Answer 6

Primary is aldosterone secreting tumor, secondary is renal artery stenosis (kidney interprets as dec blood volume)/CHF/low protein state

Symptoms: HTN, hypokalemia, metabolic alkalosis, low renin (in primary only)

Question 7

Adrenal Neuroblastoma

Answer 7

Most common adrenal medulla tumor in children (usually

Question 8

Pheochromocytoma

Answer 8

Most common tumor of the adrenal medulla in adults. Derived from chromaffin cells (neural crest). Rule of 10s: 10%malignant, 10%bilateral, 10%extraadrenal, 10%calcify, 10%kids.

Most secrete epi, NE, and DA which can cause episodic HTN. Associated with NF-1, VHL, MEN 2A and 2b. 5Ps for sypmtoms: palpitations, pallor, pain, pressure (inc BP), perspiration. Inc catecholamines and metanephrines in urine and plasma.

Question 9

Cushings Symptoms

Answer 9

BAM CUSHINGOID
Buffalo hump
Amenorrhea
Moon facies

Crazy
Ulcers
Skin changes
HTN
Infections
Necrosis of Femoral Head
Glaucoma
Osteoporosis
Immunosuppression 
Diabetes