Adrenal cortex Flashcards by Melissa Ring

What are the 3 zones of the adrenal gland

Zona glomerulosa
Zone Fasiculata
Zona reticularis

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Where are glucocorticoids made

in the zona fasiculata

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What is made in the zona reticularis

androgens

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What is cortisol used for

glucose production
BP regulation
anti-inflammatory

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What is aldosterone used for

controls sodium/potassium/water balance

regulation of blood volume

BP regulation (RAAS)

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What are glucocorticoids and mineralocorticoids used for

physiologic stress response
BP regulaation
Electrolyte homeostasis

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What is the precursor to adrenal androgen

Hehydroepiandrosterone (DHEA)

*then converted into sex steroids in gonads or target tissue

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What is the job of epi/norepi in the body

regulates heart rate
regulates contractility
vasodilation/constriction
BP regulation
bronchodilation
glycogenesis

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What is the 4S’s for the adrenal hormones

Aldosterone = salt
Costrisol = sugar
androgens = sex
epi/norepi= stress

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What causes hyper functioning adrenal glands

neoplasms
autoimmune disorders
exogenous administration

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What causes hypo functioning adrenal glands

glandular destructions
*autoimmune, infection, surgery, tumor, hemorrhage

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What are some hyperfunctioning adrenal disorders

cushings syndrome
pheochromocytoma
adrenal adenoma
adrenal cancer
multiple endocrine neoplasia

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What are some hypo functioning adrenal disorders

Addisons disease
adrenal deficiency

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Which gender is at higher risk of developing cushings syndrome

Females

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What is the most common etiology of cushings syndrome

increased ACTH production (ACTH dependent)

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What can cause an increase of ACTH production

pituitary adenoma
ectopic ACTH production

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What are some causes of ectopic ACTH production

carcinoid tumor of lung, thyroid, pancreas

small cell lung cancer

pheochromocytoma

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What are causes of ACTH independent causes of cushings syndrome

Adrenal adenoma
adrenocortical carcinoma
adrenal hyperplasia

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What is cushings syndrome

unchecked cortisol

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What are the side effects of cushings syndrome

excess in blood glucose production
increase in lipolysis
increase protein metabolism
decrease in insulin production
increased glucagon production

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How do those with Cushings syndrome typically present

central obesity
moon facies
buffalo humo
abdominal striae

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What PE findings give you a high clinical suspicion for cushings syndrome

thin, brittle skin
easy bruising (>1cm)
purple striae
proximal muscle weakness

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What are screenings for cushings syndrome

Elevated 24 hr urine free cortisol

Elevated midnight plasma

dexamethasone suppression test

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What is a positive dexamethasone suppression test

low dose = plasma cortisol >5
High dose = <50% reduction

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If a screening test for cushings is positive, how do you determine if it is ACTH dependent or independent

plasma ACTH

How do you localize the source of cushings syndrome

CT of adrenals if ACTH independent *generally benign unless >4cm and there are atypical densities

If a screening for cushings is positive and ACTH dependent, how do you localize the source

MRI of pituitary CT of chest, abdomen, thymus, pancreas, or adrenal

How do you treat cushings syndrome

If pituitary source: transsphenoidal resection of mass If ectopic ACTh scripting tumor: local surgical resection

How do you treat a benign adrenal adenoma

laparoscopic resection

How do you treat an adrenal carcinoma

surgical resection

Who is at higher risk for negative prognostic factors

older age at dx higher pre-op ACTH longer disease presence

What is a pheochromocytoma

sympathetic nervous system tumor arising from the adrenal medulla

What is the average age at dx for pheochromocytoma

What is the classic triad of a pheochromocytoma

palpitations headache episodic sweating

What is a common presentation in those with a pheochromocytoma

innapropriate fight of flight responses catastrophic HTN crisis fatal arrhythmias pulmonary edema / HF

What lab tests are preformed for pheochromocytoma

plasma fractionated free metanepherines (most sensitive)

When is plasma fractionated free metanepherines drawn

after a patient has been sitting quietly for 15 min *if positive retest after patient has been supine for 30-90 minutes

If lab testing is positive for a pheochromocytoma, what type of imaging do you obtain

non-contrast CT to look for tumor

What is the treatment of choice for a pheochromocytoma

surgical resection

What percent of pheochromocytoma are malignant

10%

What meds do those with a pheochromocytoma need to be on pre-op

alpha or CCB Beta blockers

If the pheochromocytoma is malignant, what needs to be monitored

serum chromogranin (CgA)

What is multiple endocrine neoplasia (MEN)

inherited tumor syndromes *autosomal dominant

When can MEN-1 be detected

14-18years old *clinical symptoms dont appear until 20-30

What is the mean life expectancy in someone with MEN 1

55 years because most tumors will be malignant

What is the triad of tumors in MEN1

parathyroid pancreatic islets anterior pituitary

What is the initial presenting symptom for MEN 1

hyperparathyroidism

How common is a pheochromocytoma in MEN 1

rare

What is the classic tried for MEN 2

medullary thyroid carcinoma pheochromocytoma (often bi-lat) parathyroid tumor

What is the presentation of MEN 3

mucosal neuromas Marfan-like habits pheochromocytoma medullary thyroid carcinoma

What is the most rare MEN syndrome

What is the primary diagnostic tool for MEN

genetic testing

What is the primary cause of adrenal insufficiency

adrenal gland disfunction

What is the secondary cause of adrenal insufficiency

ACTH deficiency due to hypothalamus or pituitary disfunction

What type of disease is Addisons disease

primary adrenal disease

What is the classic presentation for adrenal insufficiency

fatigue reduced stamina weakness anorexia weightloss akin hyperpigmentation

What are signs of an acute adrenal crisis

profound hypotension N/V fever dehydration

How can you confirm adrenal insufficiency

cosyntropin stimulation test (Synthetic ACTH) *should rise>20mcg/dL

What helps differentiate between primary and secondary adrenal insufficiency

plasma ACTH Low/normal = Secondary High=primary

How can you treat adrenal insufficiency

Glucocorticoid replacement therapy *hydrocortisone in 2-3 doses/day *increase dose under stress

When do the glucocorticoid replacement therapy need to be reduced in patients

when taking antifungals, HIV meds, and some antidepressants

What type of mineral corticoid replacement can be given with adrenal insufficiency

fludrocortisone acetate *generally only with PRIMARY insufficiency *helps reduce falls

How do you treat an adrenal crisis

loading dose of hydrocortisone rehydrate with saline broad spectrum abx

How can you help prevent adrenal crisis

patient education extra doses plenty of refills stress dose steroids dose adjust in hot weather antiemetics

Adrenal cortex Flashcards

(64 cards)