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Endocrine Clin med > Adrenal cortex > Flashcards

Adrenal cortex Flashcards

1
Q

What are the 3 zones of the adrenal gland

A

Zona glomerulosa
Zone Fasiculata
Zona reticularis

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2
Q

Where are glucocorticoids made

A

in the zona fasiculata

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3
Q

What is made in the zona reticularis

A

androgens

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4
Q

What is cortisol used for

A

glucose production
BP regulation
anti-inflammatory

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5
Q

What is aldosterone used for

A

controls sodium/potassium/water balance

regulation of blood volume

BP regulation (RAAS)

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6
Q

What are glucocorticoids and mineralocorticoids used for

A

physiologic stress response
BP regulaation
Electrolyte homeostasis

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7
Q

What is the precursor to adrenal androgen

A

Hehydroepiandrosterone (DHEA)

*then converted into sex steroids in gonads or target tissue

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8
Q

What is the job of epi/norepi in the body

A

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

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9
Q

What is the 4S’s for the adrenal hormones

A

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

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10
Q

What causes hyper functioning adrenal glands

A

neoplasms
autoimmune disorders
exogenous administration

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11
Q

What causes hypo functioning adrenal glands

A

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

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12
Q

What are some hyperfunctioning adrenal disorders

A

cushings syndrome
pheochromocytoma
adrenal adenoma
adrenal cancer
multiple endocrine neoplasia

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13
Q

What are some hypo functioning adrenal disorders

A

Addisons disease
adrenal deficiency

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14
Q

Which gender is at higher risk of developing cushings syndrome

A

Females

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15
Q

What is the most common etiology of cushings syndrome

A

increased ACTH production (ACTH dependent)

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16
Q

What can cause an increase of ACTH production

A

pituitary adenoma
ectopic ACTH production

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17
Q

What are some causes of ectopic ACTH production

A

carcinoid tumor of lung, thyroid, pancreas

small cell lung cancer

pheochromocytoma

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18
Q

What are causes of ACTH independent causes of cushings syndrome

A

Adrenal adenoma
adrenocortical carcinoma
adrenal hyperplasia

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19
Q

What is cushings syndrome

A

unchecked cortisol

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20
Q

What are the side effects of cushings syndrome

A

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

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21
Q

How do those with Cushings syndrome typically present

A

central obesity
moon facies
buffalo humo
abdominal striae

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22
Q

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

A

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

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23
Q

What are screenings for cushings syndrome

A

Elevated 24 hr urine free cortisol

Elevated midnight plasma

dexamethasone suppression test

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24
Q

What is a positive dexamethasone suppression test

A

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

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25
Q

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

A

plasma ACTH

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26
Q

How do you localize the source of cushings syndrome

A

CT of adrenals if ACTH independent

*generally benign unless >4cm and there are atypical densities

27
Q

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

A

MRI of pituitary

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

28
Q

How do you treat cushings syndrome

A

If pituitary source: transsphenoidal resection of mass

If ectopic ACTh scripting tumor: local surgical resection

29
Q

How do you treat a benign adrenal adenoma

A

laparoscopic resection

30
Q

How do you treat an adrenal carcinoma

A

surgical resection

31
Q

Who is at higher risk for negative prognostic factors

A

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

32
Q

What is a pheochromocytoma

A

sympathetic nervous system tumor arising from the adrenal medulla

33
Q

What is the average age at dx for pheochromocytoma

A

40

34
Q

What is the classic triad of a pheochromocytoma

A

palpitations
headache
episodic sweating

35
Q

What is a common presentation in those with a pheochromocytoma

A

innapropriate fight of flight responses

catastrophic HTN crisis
fatal arrhythmias
pulmonary edema / HF

36
Q

What lab tests are preformed for pheochromocytoma

A

plasma fractionated free metanepherines (most sensitive)

37
Q

When is plasma fractionated free metanepherines drawn

A

after a patient has been sitting quietly for 15 min

*if positive retest after patient has been supine for 30-90 minutes

38
Q

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

A

non-contrast CT to look for tumor

39
Q

What is the treatment of choice for a pheochromocytoma

A

surgical resection

40
Q

What percent of pheochromocytoma are malignant

A

10%

41
Q

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

A

alpha or CCB
Beta blockers

42
Q

If the pheochromocytoma is malignant, what needs to be monitored

A

serum chromogranin (CgA)

43
Q

What is multiple endocrine neoplasia (MEN)

A

inherited tumor syndromes
*autosomal dominant

44
Q

When can MEN-1 be detected

A

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

45
Q

What is the mean life expectancy in someone with MEN 1

A

55 years because most tumors will be malignant

46
Q

What is the triad of tumors in MEN1

A

parathyroid
pancreatic islets
anterior pituitary

47
Q

What is the initial presenting symptom for MEN 1

A

hyperparathyroidism

48
Q

How common is a pheochromocytoma in MEN 1

A

rare

49
Q

What is the classic tried for MEN 2

A

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

50
Q

What is the presentation of MEN 3

A

mucosal neuromas
Marfan-like habits
pheochromocytoma
medullary thyroid carcinoma

51
Q

What is the most rare MEN syndrome

A

4

52
Q

What is the primary diagnostic tool for MEN

A

genetic testing

53
Q

What is the primary cause of adrenal insufficiency

A

adrenal gland disfunction

54
Q

What is the secondary cause of adrenal insufficiency

A

ACTH deficiency due to hypothalamus or pituitary disfunction

55
Q

What type of disease is Addisons disease

A

primary adrenal disease

56
Q

What is the classic presentation for adrenal insufficiency

A

fatigue
reduced stamina
weakness
anorexia
weightloss
akin hyperpigmentation

57
Q

What are signs of an acute adrenal crisis

A

profound hypotension
N/V
fever
dehydration

58
Q

How can you confirm adrenal insufficiency

A

cosyntropin stimulation test (Synthetic ACTH)

*should rise>20mcg/dL

59
Q

What helps differentiate between primary and secondary adrenal insufficiency

A

plasma ACTH
Low/normal = Secondary
High=primary

60
Q

How can you treat adrenal insufficiency

A

Glucocorticoid replacement therapy
*hydrocortisone in 2-3 doses/day

*increase dose under stress

61
Q

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

A

when taking antifungals, HIV meds, and some antidepressants

62
Q

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

A

fludrocortisone acetate
*generally only with PRIMARY insufficiency

*helps reduce falls

63
Q

How do you treat an adrenal crisis

A

loading dose of hydrocortisone
rehydrate with saline
broad spectrum abx

64
Q

How can you help prevent adrenal crisis

A

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

Endocrine Clin med (6 decks)

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