Wk1 Adrenal Path Flashcards
BBIIG roles or cortisol:
Blood pressure
Bone (breaks down)
Inflammation (supresses)
Immune sys (supresses)
Gluconeogenesis (stimulates)
Most common cause of Cushing Syndrome:
Iatrogenic
–exogenous steroids
labs in Iatrogenic Cushing’s:
high cortisol
low ACTH
Cushing DISEASE
pituitary etiology producing too much ACTH
labs in Cushing DISEASE
high cortisol (can suppress with high Dex)
high ACTH
three causes of adrenal Cushing
adenoma
hyperplasia
carcinoma
labs in adrenal Cushing
high cortisol
low ACTH (already suppressed so Dex in non-dx)
Common cause of paraneoplastic Cushing
SCC lung
Would Dex challenge supress ACTH in SCC?
no, not part of axis
“fake ACTH”
Sx of primary hyperaldosteronism
HTN (hypernatremia)
Weakness/fatugue/psychosis (hypokalemia)
Renin in primary hyperaldosteronism?
low
Cause of secondary hyperaldosteronism?
high Renin
sudden virilization
abd mass
ugly tumor
bad prog
adrenocortical carcinoma
Most common cause of Congenital Adrenal Hyperplasia
21-hydroxylase deficiency
see slide
43 – CAH causes
Autoimmune destruction of adrenal cortex:
Addisons
PE findings of Addisons:
low BP
skin pigmentation – from too much MSH
Three causes of ACUTE adrenal insufficiency:
- Addison crisis
- Rapid steroid withdrawl
- massive adrenal hemmorrhage
Bacterial infx (N. meningitidis)
hypotension/shock
DIC
massive BL adrenal hemmorrhage
RAPIDLY progressive
Waterhouse-Friderichsen Syndrome
Secondary Adrenal insufficiency causes:
pituitary or hypothalamic
low cortisol
normal aldo – RAAS still intact
Neoplasm of catecholamine producing cells
pheochromocytoma
zellballen
pheochromocytoma
derived from neural crest cells
common in childhood
neuroblastoma
better prog in neuroblastoma
hyperdiploid tumor
fewer N-myc
