ADRENAL Flashcards
Two causes of Conn’s syndrome
Increased aldosterone
75% unilateral adenoma
25% bilateral hyperplasia
Tx of bilateral adrenal hyperplasia
Spironolactone + CCB
Tx of unilateral adenoma causing Conn’s
Resection
Waterhouse Friedrickson
Adrenal hemorrhage with meningococcal sepsis
Cushing’s disease - most commonly due to?
80% of non iatrogenic causes are due to pituitary micro adenoma causing increased ACTH
What is a “medical adrenalectomy”
Metryapone and aminoglutethimide
Regardless of size, an adrenal mass should be removed if :
Functioning
Growing
OR
Suspicious (brighter) on T2 MRI
Remove adrenal mass lesions greater than …
4-6 cm since there is a 15% chance of malignancy if > 6 cm. The risk increases with size.
How does cortisol affect intravascular volume?
Positive chronotropic and inotropic effects on heart and helps maintain BP by stimulation angiotensin release and inhibiting synthesis of prostaglandin I2, a potent vasodilator
How do glucocorticoids retard wound healing
Decrease IL-2 production and release and lymphocyte activation, as well as making PMNs less responsive and less efficient for chemotaxis and phagocytosis
Where does aldosterone act
Distal convoluted tubule –reabsorb sodium and indirectly free water, and to excrete K and H
Feedback loop involving cortico tropic releasing hormone
Hypothalamus releases CRH – > delivered to anterior pituitary and pituitary releases ACTH –> adrenal glands synthesize/ please cortisol.
Pheochromocytoma : best screening test
Measurement of 24 hr urinary metanephrines due to very high specificity and sensitivity.
MEN I
prolactinoma
parathyroid (HYPERPLASIA, not adenoma!)
pancreas (gastronoma)
Tx of MEN I should start with ..
Treatment of hyperparathyroidism. Since it’s hyperplasia, you have to do all 4 glands with auto implantation.
