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Flashcards in Adrenal Disease Deck (29)
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1

adrenal cortex produces what?

- glucocorticoids
- mineralocorticoids
- sex hormones (mainly tertosterone)

2

principal glucocorticoid

cortisol

3

principal mineralocorticoid

aldosterone

4

main effects of aldosterone

- increased Na+ reabsorption
- K+ and H+ excretion

(both at distal renal tubule)

5

potential causes of Cushing's syndrome

- steroid therapy
- adrenal hyperplasia
- adrenal carcinoma
- ectopic ACTH

6

cause of Cushing's disease

ACTH secreting pituitary tumor

7

clinical features of Cushing's

- moon face
- thin skin
- easy bruising
- HTN (60%)
- hirsutism
- obesity w/ centripetal distribution
- buffalo hump
- muscle weakness
- DM (10%)
- OP (50%)
- aseptic necrosis of hip
- pancreatitis (esp w/ iatrogenic Cushing's syndrome)

8

potential problems w/ Cushing's

- hyperglycemia --> +/- insulin
- hypokalemia --> arrhythmias, muscle weakness, post-op respiratory impairment
- HTN
- polycythemia
- HF

9

common cause of primary adrenocortical insufficiency

autoimmune adrenalitis (Addison's disease)

10

other causes of primary adrenocortical insufficiency

- adrenal infiltration w/ tumor
- leukemia
- infection (TB or histoplasmosis)
- amyloidosis

11

cause of secondary adrenocortical insufficiency

ACTH (adrenocorticotrophic hormone) deficiency

12

acute (Addisonian) crisis may result from

- after sepsis
- pharmacological adrenal suppression
- adrenal hemorrhage a/w anticoagulation

13

acute (Addisonian) adrenocortical crisis may also present as

post-partum pituitary infarction (Sheehan's syndrome)

14

clinical features of acute adrenocortical crisis

- apathy
- hypotension
- coma
- hypoglycemia
- circulatory failure and shock
- h/o recent infection

15

chronic adrenocortical deficiency may result from

- surgical adrenalectomy
- autoimmune adrenalitis
- secondary to pituitary dysfunction

16

clinical features of chronic adrenocortical crisis

- fatigue
- weakness
- weight loss
- nausea
- hyperpigmentation
- hypotension
- hyponatremia
- hyperkalemia
- eosinophilia
- occasionally hypoglycemia

17

bmp results in adrenocortical insufficiency

- hyponatremia
- hypochloremia
- hyperkalemia
- hypercalcemia
- hypoglycemia
- elevated BUN

18

cbc results in adrenocortical insufficiency

- elevated hematocrit (from dehydration)
- possible eosinophilia

19

expected cortisol level in adrenocortical insufficiency

low

20

expected ACTH level in priamry adrenocortical insufficiency

high

21

expected ACTH level in secondary adrenocortical insufficiency

low or normal

22

abg results in adrenocortical insufficiency

metabolic acidosis +/- respiratory acidosis if severe muscle weakness

23

management of adrenocortical insufficiency

- admit to critical care unit
- invasive monitoring or circulatory pressures
- abgs

24

management of circulatory shock in acute adrenocortical crisis

- large volumes of isotonic saline (6-8 liters) in 24 hours
- +/- inotropic therapy
- corticosteroids!! (don't wait for confirmatory lab results)

25

steroid of choice in acute adrenocortical crisis

hydrocortisone (100-200 mg bolus) then q6h

26

patients who have been on steroids for how long and how much are at risk of acute Addisonian-type crisis from steroid w/d?

10 mg daily > 1 year

27

cause of primary hyperaldosteronism (Conn's syndrome)

adenoma in zona glomerulosa secreting aldosterone

28

clinical features of primary hyperaldosteronism (Conn's syndrome)

- hypokalemia
- muscle weakness
- HTN

29

problems w/ primary hyperaldosteronism (Conn's syndrome)

- hypokalemia --> cardiac arrhythmias, post-op weakness, ventilatory impairment
- HTN
- hormone replacement post adrenalectomy