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Adrenal 1 Flashcards

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1
Q

What are the different parts of the adrenal gland and what does each section secrete?

A
  • Cortex (Can think “GFR–> ACE”)
    • outer: Zona Glomerulosa–> Aldosterone
    • middle: Zona Fasciculata –> Cortisol
    • Inner: Zona Reticularis –> Androgens/DHEA (think Estrogens for mnemonic)
  • Medulla–> Catecholamines (NE and Epi)
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2
Q

Aldosterone vs. cortisol: which is the mineralcorticoid? Which is the glucocorticoid?

A

Aldosterone= mineralcorticoid (“Al mines”)

Cortisol= Glucocorticoid

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3
Q

Which hormone is pulsatile and diurnal (AM>PM)?

A

Cortisol

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4
Q

What is cortisol under control of

A

ACTH

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5
Q

Which hormone?

  • Stress, trauma, etc cause release
  • Protects against hypoglycemia
  • Inhibits production of inflam. mediators
  • Suppression of immune response
  • Enhance vascular responsiveness to catecholamines
A

Cortisol

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6
Q

Which hormone?

  • Increases force/rate of contraction of heart
  • Vasoconstriction
  • Bronchodilation
  • Stimulation of lipolysis
  • Increase metabolic rate
  • pupil dilation
  • Inhibition of non-essential processes
A

Catecholamines (Epi/NE)

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7
Q

What is the long term response to stress? (

A
  • Mineralcorticoids (Aldosterone)
    • retention of Na and H20
    • Incr. blood volume and BP
  • Glucocorticoids (cortisol)
    • protein and fats converted to glucose
    • hyperglycemia
    • suppression of immune system
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8
Q

Is a stimulation test used to evaluate for hypo or hyperfunction? A suppression test?

A

Stimulation test= hypofunctioning

Suppression test= Hyperfunctioning

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9
Q

What is 24hr urinary free cortisol a test for

A

hypercortisolism

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10
Q

What does a serum cortisol value <3mg/dL on a serum total cortisol test very likely indicate?

A

Adrenal insufficiency

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11
Q

What is the main use of obtaining a plasma ACTH?

A

Adrenal insufficiency:

Differentiate primary (adrenal) vs secondary (pituitary) vs. tertiary (hypothalmic)

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12
Q

What does an ACTH stimulation test (using synthetic ACTH- Cosyntropin) evaluate for?

A

Differentiate source of adrenal insufficiency (cortisol deficiency)

(if no increase from baseline= adrenal insufficency)

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13
Q

What would an ACTH stimulation test show in adrenal insufficiency?

A

Subnormal cortisol level response

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14
Q

What does the following indicate on a Dexamethasone suppresion test:

No change in cortisol

A

= Excess cortisol production

(normal would be cortisol suppressed)

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15
Q

What are the 4 causes of Cushings syndrome? (hypercortisolism)

A
  • ACTH dependent (MC)
    • Pituitary adenoma (MC overall)–> cushings DISEASE
    • NET producing ACTH- small cell lung cancer, ovarian cancer
  • ACTH independent
    • Chronic glucocorticoid use (2nd MC)
    • Adrenocortical tumor (benign or malignant
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16
Q

What are the 2 MC causes of Cushings syndrome?

A
  1. Pituitary adenoma (MC overall, ACTH dependent)–> Cushings Disease
  2. Chronic glucocorticoid use (ACTH independent)
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17
Q

What is Cushings Sydrome?

A

Signs and symptoms due to prolonged exposure to excess cortisol

(Cushings Disease is de to Pituitary adenoma)

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18
Q

S/s of what?

  • Central obesity
  • moon face
  • cervical fat pad
  • Purple abdominal striae
  • Fatigue
  • Prox mm. weakness
  • HTN
  • Insulin resistance
A

Cushings syndrome

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19
Q

What 3 things may be seen in Cushings syndrome specifically in women

Study These Flashcards
A

Hirsutism

Acne

Menstrual irregularities

20
Q

How do you dx Cushing syndrome?

(screening for Cushings- 3 tests, Differentiating causes- 1 test)

Study These Flashcards
A
  • Clinical suspicion
  • Screening for Cushings:
    • 24hr urine cortisol: elevated
    • Midnight salivary cortisol levels: Incr. on 2 separate occations
    • Dexamethasone suppression test: NO CHANGE in cortisol levels
  • Differentiating causes:
    • Plasma ACTH:
      • < 6 (at any time)= adrenal tumor
      • > 80 @8am or >50 @4pm= Pituitary adenoma or ectopic production
21
Q

How do you Differentiate causes of Cushing Syndrome? (Adrenal tumor vs Pituitary adenoma vs ectopic)

Study These Flashcards
A
  • Plasma ACTH
    • < 6 (@ any time)= adrenal tumor
    • >80 @8am or >50 @4pm= Pituitary adenoma or ectopic production
22
Q

What diagnostic study should be ordered if plasma ACTH indicates a pituitary tumor? An Ectopic ACTH producting tumor? An adrenal tumor?

Study These Flashcards
A
  • Pituitary tumor- MRI
  • Ectopic ACTH producing tumor- CXR, pelvic U/S
  • Adrenal tumor- CT abdomen
23
Q

How do you tx Cushings syndrome if it is due to exogenou steroids?

Study These Flashcards
A

taper to lowest dose

24
Q

How do you tx Cushings syndrome if it is due to pituitary adenoma?

Study These Flashcards
A

transsphenoidal resection

25
How do you tx Cushings syndrome if it is due to adrenal tumor
**adrenalectomy** (Replacement therapy if this causes iatrogenic adrenal insufficiency)
26
How do you **medically treat Cushings** if the patient is not a surgical candidate? (5)
1**. _Mitotane_ (**permanent destruction of adrenal cells) 2. **_Ketoconazole_** (inhib. prod of cortisol) 3. **Metyrapone** (inhib. prod of cortisol) 4. **Mifepristone** 5. **Pasireotide** (inhib ACTH secretion)
27
What is adrenal insufficency?
Inadequate production of adrenal hormones--\> dysfunction/absence of adrenal cortices
28
What is the MCC of Adrenal insufficiency in the US?
Addisons disease (autoimmune cortical destruction) (this is a primary cause of adrenal insufficiency)
29
What is the MCC of adrenal insufficiency **worldwide**
_**TB** (_primary adrenal insufficiency)
30
What is the MC secondary cause of adrenal insufficiency
Long term exogenous steroids (--\> suppression of HPA axis--\> abrupt withdrawal--\> Addisons crisis)
31
Hallmark tetrad of what? * Weakness/fatigue * weight loss/anorexia * **_hyperpigmentation_** (of non-sun exposed areas) * orthostatic hypotension
**Adrenal insufficiency** (Hyperpigmentation specifically for Addisons)
32
Adrenal insufficiency: The following are s/s of deficiency of which hormone? * **weakness/fatigue** * hypoglycemia * wt loss/anorexia * N/V, abd pain
* Glucocorticoid deficiency
33
Adrenal insufficiency: The following are s/s of deficiency of which hormone? * **_Na wasting (_**hyponatremia, salt craving) * Hypovolemia * orthostatic hypotension * **hyperkalemia** * mild metabolic acidosis
Mineralcorticoid deficiency
34
Adrenal insufficiency: The following are s/s of deficiency of which hormone? * Loss of axillary and pubic hair * amenorrhea
Adrenal androgen deficiency in females
35
What causes Addisons crisis? What are triggers?
Extremely low cortisol! Triggers= stress (infection, trauma, sx)
36
T/F: Addison's Crisis can be treated on an outpatient basis
FALSE. This is a MEDICAL EMERGENCY
37
Addisons crisis is MC in what?
primary adrenal insufficiency
38
S/s of what? * **SUDDEN** ONSET: * **hypotension** * **acute abd/back pain** * N/V/D * Fever * dehydration * **AMS**
Addison's Crisis
39
How do you tx Addison's crisis? (4)
_MEDICAL EMERGENCY_ 1. **IV hydrocortisone and fludrocortisone** 2. Correct electrolyte abnormalities 3. 50% dextrose 4. Volume resusitation
40
How do you dx Arenal insufficiency? (7)
1. CMP: hyperkalemia, hyponatremia, fasting hypoglycemia 2. Eosinophilia 3. +/- anti-adrenal antibodies 4. **_AM plasma cortisol \< 3_**= adrenal insuff. 5. **_Plasma ACTH level_** ( \>80 @8am or \>50 @4pm)= pituitary adenoma or ectopic) 6. **_ACTH stimulation test:_** **No change** in cortisol= adrenal insufficiency 7. CT of abd/pelvis, MRI of pituitary
41
What are the 3 causes of **_secondary_** adrenal insufficiency
1. **Long term exogenous steroids** (MC) 2. **Hypopituitarism** 3. Meds (decr. corticosteroid levels): phenytoin, opiates, rifampin, ketoconazole
42
Compare Addisons disease (primary adrenal insufficiency) and hypopituitarism in regards to cortisol and ACTH
Addisons: decr. Cortisol and **_incr._ ACTH** Hypopituitarism: Decr. cortisol and **_decr_. ACTH**
43
How do you treat primary adrenal insufficiency (Addisons disease)?
**Hydrocortisone** (glucocorticoid) + **Fludrocortisone** (mineralcorticoid)
44
How do you treat secondary/tertiary adrenal insufficiency?
**Hydrocortisone** ONLY (Dont need fludrocortisone b/c RAAS manages aldosterone)
45
What might you give women with adrenal insufficiency
DHEA

GK F3E4 (12 decks)

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