Adrenal Disease Flashcards
(28 cards)
A 38 yo female presents complaining of weakness, fatigue, and unintentional weight loss. She also complains of abdominal pain, nausea, salt craving, and dehydration. On exam you find she has a low-grade fever, hyperpigmentation of her palms, and delayed DTRs. What is the most likely diagnosis? What treatment do you recommend for her?
Addison's Disease Glucocorticoid and mineralcorticoid replacement Lowest possible dose of hydrocortisone DHEA She should wear a medi-alert bracelet
A 45 yo pt presents complaining of weakness, strange dark creases on her hands, nausea and vomiting, salt cravings, feeling dizzy when she sits up, and muscle pain. What is the most likely cause of this patient’s disease?
Addison’s Disease
Most likely caused by autoimmune destruction of the adrenal cortex
A pt presents complaining of depression, lethargy, hand creases, abdominal pain, weight loss, joint pain, and anxiety. The patient has a history of chronic steroid use. What is the most likely pathologic cause of this pt’s disease?
Addison’s Disease
Primary adrenal insufficiency
High ACTH
Low corticosteroids
A 45 yo pt presented with weakness, anorexia, weight loss, salt craving, hypotension, delayed DTRs, and depression. If you suspect Addison’s Disease, what diagnostic tests should you run?
8am plasma cortisol
ACTH stimulation test
A pt presented with weakness, anorexia, nausea, orthostatic hypotension, dehydration, and myalgia. The lab results show hypoglycemia, elevated plasma ACTH, hyponatremia, and hyperkalemia. What disease do you suspect? What treatment should you recommend?
Addison's Disease Glucocorticoid and mineralcorticoid replacement Hydrocortisone DHEA (women only) Medi-alert bracelet
What are the possible causes of Addison’s Disease?
Autoimmune destruction of the adrenal cortex (MC)
Chronic steroid use
Chronic infection (TB - MC)
Metastatic carcinoma
Iatrogenic
Chronic cortisol, aldosterone, or adrenal androgen/estrogen deficiency
If you have a patient with Addison’s Disease, what is the most important thing to remember about their treatment?
You must INCREASE their hydrocortisone during illness or stress!
What will happen to an Addison’s Disease patient that stops taking their steroidal meds?
Adrenal Crisis
What are the 2 causes of Adrenal Crisis?
Patient stops taking steroidal meds (MC)
Stressful periods without glucocorticoid dose adjustment (infection, trauma, surgery)
How do you treat Adrenal Crisis?
Reverse hypotension and electrolyte abnormality
Replace glucocorticoid
IV isotonic normal saline
A pt presents with central obesity, thin extremities, hypertension, amenorrhea, hirsutism and polydipsia. You order an MRI which shows a pituitary adenoma. What is the most likely diagnosis?
Cushing’s DISEASE
What causes Cushing’s Disease?
Pituitary adenoma that causes excess ACTH secretion
Adrenal excess
What is the most common cause of endogenous hypercortisolism?
Cushing’s DISEASE
What is the difference between Cushing’s Disease and Cushing’s Syndrome?
The etiology
Cushing’s Disease is caused by a pituitary adenoma
Cushing’s Syndrome is caused by anything that causes adrenal excess
A patient presents with central obesity, a protuberant abdomen, thin extremities, hypertension, hirsutism, purple striae, and depression. He mentions that he has a long-term history of Prednisone use. What tests should you recommend? What findings would you expect to see?
Cushing’s Syndrome
24-Hour urinary free cortisol level - expect it to be high on 3 separate collections
DST (dexamethasone suppression test) - expect an 8am cortisol > 0.5mcg/dL in Cushing’s; expect no response if adrenal cortisol/ectopic ACTH tumors
A patient presents with central obesity, a protuberant abdomen, thin extremities, hypertension, hirsutism, purple striae, and depression. He mentions that he has a long-term history of Prednisone use. Labs show that the patient has Cushing’s Syndrome. What is the underlying cause of this patient’s Cushing’s?
Glucocorticoid hormone exposure (Prednisone) - MC exogenous cause
What can cause Cushing’s Syndrome?
Glucocorticoid hormone exposure
Adrenocorticol tumors (ACTH dependent)
Non-pituitary ACTH secreting tumors (SCLC) (ACTH dependent)
Ectopic CRH (ACTH independent)
Describe how a DST is performed and what the results indicate.
DST = Low-Dose Dexamethasone Suppression Test
1mg Dexa given at 11pm
Check 8am cortisol
8am cortisol > 0.5mcg/dL = Cushing’s
No response could be due to an adrenal cortisol/ectopic ACTH tumor
Cushing’s Disease is harder to suppress with low-dose DST
How do you treat Cushing’s Syndrome? (generic)
Treat the underlying cause
How would you treat a patient who has developed Cushing’s Syndrome as a result of long-time Prednisone use?
Slowly reduce the glucocorticoid to the lowest effective dose
What medications could you give a Cushing’s patient that has cortisol excess?
Ketoconazole
Metyrapone
How would you treat a patient whose Cushing’s Disease is caused by a pituitary adenoma?
Transsphenoidal surgery to remove the adenoma
Maintain them on steroids
What are common complications of Cushing’s Syndrome?
Death if untreated
HTN, DM
Susceptible to infections
Osteoporosis, nephrolithiasis, psychosis
A patient presents with hypertension, severe headaches, palpitations, profuse sweating, and constipation. On exam you hear cardiac arrhythmias. What disease are you concerned this could be?
Pheochromocytoma
