Flashcards in Adrenal disorders Deck (13):
Causes of primary adrenal insufficiency
AI adrenalitis, TB, amyloidosis, hemochromatosis, bilateral adrenalectomy, adrenal vein thrombosis, adrenal artery embolus, metastatic carcinoma
Causes of secondary adrenocortical insufficiency
hypopituitarism (sheehan, chromophobe adenoma, hypophysectomy) Optic gliomas, craniopharyngiomas, basal meningitis, stalk section, tumors of 3rd ventricle, encephalitis, trauma, corticosteroid administration
What symptoms should you look for in chronic adrenal insufficiency?
2. pigmentation of skin and mucous membranes
3. Weight loss
5. Anorexia, N/V
6. Salt craving
8. Syncopal episodes
What symptoms should you look for in acute adrenal insufficiency?
6. Hyponatremia, hyperkalemia
What are causes of ACTH-dependent Cushing's syndrome?
Cushing's disease, ectopic ACTH syndrome, ectopic CRH syndrome
ACTH independent cushings syndrome causes
adrenal adenoma, adrenal carcinoma, micronodular hyperplasia, macronodular hyperplasia
Causes of pseudo-cushincs syndrome
major depressive disorder, alcoholism
Biochemical tests for presence or absence of cushing's syndrome.
Circardian rhythm or plasma cortisol, low dose dexamethasone suppression, 24 hr urinary free cortisol, salivary cortisol determination
What test differentiates patients with Cushings syndrome of any cause from pt who do not have Cushings.
Low dose- dexamethasone
What biochemical tests are used for etiology of established Cushings?
high dose dexamethasone suppression. Plasma ACTH immunoassay, metyrapone test, CRH stimulation +/- petrosal sinus cath
Describe what a dexamethasone distinguishes between and how.
Pt with cushings disease from pt with ectopic ACTH syndrome and from those with adrenal tumors producing excess cortisol. This is because a pituitary tumor producing ACTH will usually respond to exogenous GC if a high enough dose is give.
What will happen with pt with Cushing's disease in a high dose dexamethasone test