Adrenal

Question 1

Adrenal Medulla secretes?

Answer 1

Catecholamines:

Epi, Norepi

Question 2

Adrenal Cortex: Zona Glomerulosa secretes?

Answer 2

Mineralcorticoids: Aldosterone

Question 3

Adrenal Cortex: Zona Fasciculata secretes?

Answer 3

Glucocorticoids: Cortisol

Question 4

Adrenal Cortex: Zona Reticularis secretes?

Answer 4

Androgens: DHEA

Question 5

Adrenal hormones excreted how?

Answer 5

Urine as metabolites

Question 6

Cushing’s Synd/ACTH-dependent caused by?

Answer 6

1) Excess ACTH from pituitary tumor ** most common
2) Excess ACTH from ectopic tumors (i.e. small cell lung CA)
3) Excess CRH from hypothalm

Question 7

Cushing’s Synd/ACTH-independent caused by?

Answer 7

1) Adrenal tumor
2) Hyperplasia from excess receptor/hormone
3) Neuroendrocrine tumor
4) Pheochromocytoma (medulla tumor)

Question 8

Cushing’s Synd/ACTH-dependent epidemiology?

Answer 8

More common
F»M
25-45yo

Question 9

Cushing’s Synd/ACTH-independent epidemiology?

Answer 9

M=F

Bimodal age

Question 10

Cushing’s presentation?

Answer 10

Weight gain
Proximal mm fatigue/weakness
Straie
Acne/hair
Edema

Question 11

Cushing’s physio ∆s?

Answer 11

HTN
Insulin resistance
Osteoporosis/hyperCa2+ 
Psych
Clitoral hypertrophy
Impotence

Question 12

Cushing’s labs? (5)

Answer 12

Easiest/cheapest: DST = cortisol >5

Definitive: 24 hr urine cortisol > 125

Plasma cortisol = high

Serum ACTH = high in ACTH-dep and low in indep

Saliva = high cortisol in p.m.

Question 13

Cushing’s management?

Answer 13

Remove/destroy tumors

Inoperable, see meds

Question 14

Cushing’s tx w/ meds?

Answer 14

Adrenolytic (Mitotane): destruction of adrenocortical cells

Adrenal Enz Inhib (Ketoconazole, Metyrapone)

Question 15

Virilization is?

Answer 15

development of male physical characteristics

Question 16

Adrenal Insufficiency is?

Answer 16

Inadequate prdxn of mineral/gluco/androgen hormones

Question 17

Primary Adrenal Insufficiency caused by? (2 categories)

Answer 17

Destruction of gland:
Autoimm, surgical, infect, CA

Metabolic failure:
adrenal hyperplasia, adrenoleukodystrophy

Question 18

Most common cause of Primary Adrenal Insufficiency?

Answer 18

Addison’s (autoimmune)

Question 19

Secondary Adrenal Insuff caused by?

Answer 19

Abrupt stop of external steroid (most common)
Hypopituitary
Steroid-reducing drugs

Question 20

Adrenal Insuff presentation?

Answer 20

TETRAD:
Weak/fatigue
Weight loss
Hyperpigment (include muc memb)
HypoTN

Question 21

Adrenal Insuff from ↓ glucocort presentation?

Answer 21

Tetrad
+ hypoglycemia
N/V abd pain

Question 22

Adrenal Insuff from ↓ mineralcocort presentation?

Answer 22

Tetrad
+ hypoNa+/hypovol
HyperK+
Acidosis

Question 23

Adrenal Insuff from ↓ androgens presentation?

Answer 23

Tetrad

+ Ø pubic hair/amenorrhea in women

Question 24

Adrenal Insuff labs?

Answer 24

Cosyntropin Stim Test: baseline cortisol then post ACTH bolus cortisol
+ result = cortisol Ø ↑ > 18 AND Ø ↑ > 7 above baseline
(doesn’t tell me cause)

Plasma cortisol = low
Serum ACTH = high (addison’s), low (hypopitu)

Question 25

Adrenal Insuff diagnositcs must r/o?

Answer 25

TB (PPD test) Lung/Breast CA Vascular dz

Question 26

Adrenal Insuff rx?

Answer 26

Replace hormones | Increase glucocort during stress

Question 27

Primary Hyperaldosteronism (Conn Synd) caused by?

Answer 27

(U) Adrenocortical adenoma | Cortical hyperplasia

Question 28

Conn synd presentation?

Answer 28

``` HTN HypoK+ mm weakness Paresthesia HA Polyuria/Polydipsia ```

Question 29

Conn Synd labs/test?

Answer 29

Plasma and urine aldosterone = high Plasma renin = low CT for adenoma

Question 30

Conn Synd tx?

Answer 30

Remove tumor | Spironolactone/antihypertensives

Question 31

Pheochromocytoma is?

Answer 31

Catecholamine-producing tumor of neurochromaffin cells

Question 32

Pheochromocytoma epidemiology?

Answer 32

Sporadic or Familial any age (peak 40-50yo) Fatal if not tx

Question 33

Pheochromocytoma etiology?

Answer 33

(U) in medulla or extra-adrenal (P) neurofibromatosis RULE OF 10s

Question 34

Extraadrenal Pheochromocytoma located?

Answer 34

SNS spinal chain Aorta Ureter Bladder

Question 35

Pheochromocytoma presentation?

Answer 35

Paroxysm attacks: HA, sweating, palp, acute HTN (P) mass Thyroid storm

Question 36

Key point of Pheochromocytoma-caused HTN?

Answer 36

If pt HTN not responding to tx, workup for catecholamine excess

Question 37

Pheochromocytoma labs?

Answer 37

Definitive: Clonidine Suppress Test = no epi reduction after clonidine Thyroid fxn Plasma/urine catecholamnies/metabolites 24 hr urine catech, metaneph, VMA

Question 38

Causes of false + for catecholamines/metanephrines?

Answer 38

``` TCA Beat block Acetamin ETOH HTN med w/draw MI/stroke/sleep apnea ```

Question 39

Pheochromocytoma tx?

Answer 39

IV nitro for crisis Chemical sympathectomy w/ alpha block (surgical prep) Surgery