Adrenal disorders Flashcards Preview

Clin Med-Endocrine > Adrenal disorders > Flashcards

Flashcards in Adrenal disorders Deck (31):
1

what is produced in the zona glomerulosa

mineralocorticoid production (aldosterone)

2

what is made in the zone fasciculata

glucocorticoid production

3

what is made in the zona reticularis

androgen production( testosterone, important in female sexuality)

4

what is made in the medulla

catecholamines(epinephrine,norepeinephrine,dopamine)

5

what does alodsterone stimulate and what is its goal

stimulated ronal tubule sodium reabsorption and potassium excretion.
The goal is to increase intravascular volume

6

what is the function of cortisol

inhibits insulin
regulated metabolism of proteins, carbs, fats
highest at 6am lowest at 12 (diurnal pattern)
increases with exercise and stress
increases in trauma, infection
required for angiotensin II prod

7

what is the most common cause of Addison's disease

autoimmune destruction of adrenal cortex

8

what are signs and symptoms associated with addisons disease

weakness, fatigability, low grade fever
hyperpigmentation
anorexia, weight loss, abdominal pain, salt craving, dehydration, hypotension, myalgias, arthralgias, delayed deep tendon reflexes, lethargy, confusion

9

What do labs look like in a person with Addison's

hypoglycemia, plasma ACTH is elevated, low serum sodium, elevated potassium

10

How is it diagnosed?

low plasma cortisol at 8am is diagnostic with elevated plasma ACTH level >200pg/ml
anti-adrenal antibodies in autoimmune disease
corticotropin stimulation test failed adrenal response is confirmatory

11

how is chronic Adrenocortical insufficiency treatment

replacement of glucocorticoids and mineralocorticoids
hydrocortisone
DHEA
medical alert bracelet

12

what is the cause of adrenal crisis

occurs in patients who stop their steroidal medications

13

when else can an adrenal crisis happen

occur in stressful periods without prior glucocorticoid dose adjustment: infection, trauma, surgery

14

what is the goal of treatment with adrenal crisis?

revers hypotension and electrolyte abnormalities
IV- isotonic normal saline
replace glucocorticoids

15

what is the definition of cushing's disease

causes by excess secretion of ACTH by a pituitary adenoma

16

what is the most common cause of endogenous hypercortisolism

cushings disease

17

what is the cause of cushing's syndrome

adrenocortical tumors
non-pituitary ACTH secreting tumors
Ectopic CRH
chronic exposure to glucocorticoids hormones such a prednisone

18

what are the signs and symptoms of cushings syndrome

central obesity
supraclavicular fat pads, protuberant abdomen
hypertensionm decreased glucose tolerance
amenorrhea, weakness
potassium excretion and NA retention and Ca loss
immunosupression
Hirsutism, osteoporosis, thirst, polyuria, renal calculi, acne, purple striae, impaired wound healing, susceptible to infections

19

what does 24 hour urinary free cortisol level look like

levels high in cushings disease in 3 separate collections

20

what does the salivary cortisol level look like in cushings

high but normally it should be low

21

when performing low dose dexamethasone suppression test what will cortisol levels look like

the cortisol gets checked at 8am and will diagnose cushings if cortisol is high >0.5 mcg/dl

22

what does high dose dexa supression test differentiate between

cushings syndrome or disease

23

What will the cortisol levels look with with the dexa supression test?

cushings disease is harder to suppress with low dose dexa
adrenal adenomas and ectopic ACTH tumors do not respond to high dexa test

24

what is the treatment for cushings id caused by long term use of glucocorticoids hormones

the dosage is gradually reduced to the lowest dose adequated for control of the indicated disorder

25

what is the treatment for adenoma, adrenal adenoma

surgery

26

what are the complications with cushings

untreated can cause death
complications of hypertension and diabetes
increased susceptibility to infections
osteoporosis, nephrolithiasis, psychosis

27

what is pheochromocytoma

excessive catecholamine secreted from a tumor in the adrenal medulla

28

what are the signs and symptoms of pheochromocytoma

hypertension
classic triad- severe headache, palpitations, profuse sweating and range from monthly to multiple episodes
cardiac arrythmias
intracerebral hemorrhage
hypertensive encephalopathy,epigastric pain, weakness, constipation, heart failure

29

who should be screened for a pheochromocytoma

pateints with difficult to control hypertension
pts requiring more than 4 blood pressure meds
patients with onset of HTN before 35yo or after the age of 60

30

what type of labs would you want to do on a patient with pheocromocytoms

urinary catecholamines, total and fractionated metanephrines, vanillylmandelic acid and creatinine
direct plasma assay

31

what is the treatment for pheochromocytoma

surgical removal of tumor or adrenal gland