adrenal gland

Question 1

In response to low serum cortisol or stress…

Answer 1

the hypothalamus secretes corticotropin releasing factor (CRF)

Question 2

In response to CRF…

Answer 2

the pituitary releases adrenocorticotropic hormone (ACTH)

Question 3

In response to ACTH …

Answer 3

the adrenal glands secrete cortisol

Question 4

In response to elevated cortisol levels…

Answer 4

the hypothalamus decreases production of CRF

Question 5

Cortisol is produced by the ___ in a reaction to ___. Its main functions are to suppress ___ and increase available ___ by increasing ___ levels and promoting the breakdown of __ and ___. It also regulates ___

Answer 5

Cortisol is produced by the adrenal glands in a reaction to stress. Its main functions are to suppress the immune response and increase available energy by increasing blood sugar levels and promoting the breakdown of fat and protein. It also regulates electrolytes.

Question 6

Cushing’s syndrome = ____ cortisol production

Addison’s disease = ___ cortisol production

Answer 6

Cushing’s syndrome = excessive cortisol production

Addison’s disease = low cortisol production

Question 7

Cushing’s disease
Pituitary …
gender

Answer 7

Cushing’s disease

• Pituitary adenoma with hypersecretion of ACTH stimulating cortisol production in the adrenals.
• Women have a three times greater chance of having this than men.

Question 8

Cushing’s syndrome

3 causes

Answer 8

• Adrenal tumor producing an increase in cortisol
• Ectopic production of ACTH – most commonly a small cell lung cancer
• Long term use of corticosteroids usually in treatment of another disease

Question 9

cushing’s disease vs syndrome

Answer 9

syndrome is caused by an outside source (outside)

disease is caused by an inside source (pituitary)

Question 10

most specific signs of cushings

Answer 10

proximal mm weakness, pigmented striae more than 1 cm wide(thigh, breast, abdomen), buffalo hump, truncal obesity, hirsutism

Question 11

Sexual issues
hirsutism
Oligomenorrhea or amenorrhea
erectile dysfunction

Answer 11

cushings

Question 12

Skin
poor wound healing
acne
superficial skin infections
bruising

Answer 12

cushings

Question 13

Thirst and polyuria
Problems with calcium including kidney stones, osteoporosis, avascular necrosis
Mental – there is a spectrum from decreased concentration up through frank psychosis

Answer 13

cushings

Question 14

cushings skin symptoms

Answer 14

poor wound healing
acne
superficial skin infections
bruising

Question 15

cushings

-glucose, K++, cortisol

Answer 15

Glucose elevated
Hypokalemia
Cortisol is elevated

Question 16

Glucose elevated
Hypokalemia
Cortisol is elevated

Answer 16

cushings

Question 17

ACTH (cushings)
elevated
low

Answer 17

ACTH
elevated – pituitary or ectopic adenoma
low – adrenal tumor

Question 18

cushings
MRI
CT

Answer 18

MRI for pituitary tumor

CT for adrenalcortical or other tumors

Question 19

For Cushing’s disease (pituitary adenoma) tx

Answer 19

transsphenoidal resection

Question 20

cushings: tumors causing the problem tx

Answer 20

Surgical removal of tumors causing the problem is the best option in all cases were that is possible, otherwise chemotherapy or radiation therapy is a possibility

Question 21

If tumor cannot be destroyed or removed..

Answer 21

If tumor cannot be destroyed or removed – metyrapone and ketoconazole may suppress hypercortisolism. Parenteral octreotide may suppress ACTH

Question 22

Parenteral octreotide…

Answer 22

Parenteral octreotide may suppress ACTH

Question 23

what may suppress ACTH

Answer 23

Parenteral octreotide

Question 24

what may suppress hypercortisolism.

Answer 24

metyrapone and ketoconazole may suppress hypercortisolism.

Question 25

metyrapone and ketoconazole

Answer 25

may suppress hypercortisolism.

Question 26

Often patients treated for Cushing’s syndrome will go into ___ withdrawal, ...

Answer 26

cortisol withdrawal, Addison’s disease, and require hydrocortisone or prednisone.

Question 27

adrenal cortex releases what 3 things

Answer 27

steroid hormones, aldosterone, cortisol

Question 28

aldosterone 3 functions

Answer 28

- regulates BP - retains Na - secretes K+

Question 29

cortisol functions (3)

Answer 29

- increase blood glucose - breaks down fats/proteins/carbs - regulates electrolytes

Question 30

prognosis of cushings after succesful excision of a benign adrenal adenoma

Answer 30

95% chance of a 5 year survival

Question 31

% of recurrence over 10 years with cushings

Answer 31

15-20%

Question 32

what % of addison's is secondary to autoimmune issues | - other 4 causes

Answer 32

80% Other causes include TB, genetic disorders, removal of adrenals, trauma(hemorrhaging)

Question 33

addison's secondary causes are ...

Answer 33

pituitary based

Question 34

calicification of adrenal glands

Answer 34

TB

Question 35

precipated by infection, trauma, surgery, stress, lymphoma, metastatic cancer, amyloidosis, scleroderma, hemochromatosis, cessation of corticosteroid medications

Answer 35

adrenal crisis

Question 36

There is a laundry list of vague findings including: GI symptoms(MANY), weakness, fatigue, weight loss, anorexia, muscle and joint pain, AMENORRHEA, nausea and vomiting, DELAYED deep tendon reflexes, emotional changes.

Answer 36

addison's

Question 37

Sparse axillary and pubic hair Hyperpigmentation of skin especially of creases or pressure areas (waistband/bra line) Hypotension typically systolic under 110 mmhg Small heart Salt craving

Answer 37

addison's

Question 38

addison's symptoms

Answer 38

Sparse axillary and pubic hair Hyperpigmentation of skin especially of creases or pressure areas (waistband/bra line) Hypotension typically systolic under 110 mmhg Small heart Salt craving

Question 39

addison's - menstuation - hair - reflexes - BP

Answer 39

- amenorrhea - sparse axillary and pubic hair - delayed DTR - low BP

Question 40

hyperpigmentation in addison's

Answer 40

only in primary disease when ACTH is elevated

Question 41

hypotension, acute abd or low back pain, vomiting, diarrhea, dehydration, altered mental status

Answer 41

addisonian crisis; can be fatal if untreated

Question 42

``` addison's - sodium, blood sugar, BUN - potassium, calcium ___ antibodies may be present ACTH is ___ in primary adrenal disease Plasma Cortisol is ___ ```

Answer 42

Low – sodium and blood sugar, BUN Elevated – potassium(only in primary disease), calcium Antiadrenal and antithyroid antibodies(50%) may be present ACTH is elevated in primary adrenal disease Plasma Cortisol is low

Question 43

Cosyntropin stimulation test or ACTH stimulation test

Answer 43

cosyntropin test is diagnostic; ACTH is injected and the plasma cortisol is then monitored for a reaction. - a serum cortisol rise of more than 20 after adminstration of cosyntropin is nml; anything less is suspicious

Question 44

imaging of addison's

Answer 44

Chest x-ray for TB | Abdominal CT – small adrenal glands in an autoimmune disease

Question 45

neutropenia, mild anemia, relative lymphocytosis, eosinophilia

Answer 45

addison's

Question 46

diagnostic (addison's) | - early plasma cortisol and ACTH

Answer 46

low cortisol(under 3) and elevated ACTH(over 200)

Question 47

DHEA level of 1,000 | -produced where

Answer 47

- anything higher excludes Addison's | - adrenal gland

Question 48

addison's tx

Answer 48

- Replacement with oral hydrocortisone (drug of choice) or prednisone.

Question 49

Fludrocortisone

Answer 49

Has sodium retaining properties and be adjusted for clinical symptoms like edema of hypotension.

Question 50

addison's length of steroids

Answer 50

These are given for life and should be monitored by clinical symptoms as well as blood tests to assure proper dosing throughout the patient’s lifespan

Question 51

addison's tx for improved well being, increased muscle mass, reversal of femoral neck bone loss

Answer 51

DHEA; monitor for androgenic effects

Question 52

addisonian crisis tx

Answer 52

IV saline, glucose, glucocorticoids and tx of underlying disease

Question 53

high fever low blood pressure confusion or coma hypoglycemia

Answer 53

adrenal crisis give IV saline, glucose, glucocorticoids

Question 54

primary and secondary addison's differences

Answer 54

primary: assoc with increased skin pigmentation, decreased glucocorticoids and decreased mineralcorticoids secondary: ONLY assoc with decreased glucocorticoids and DOES NOT have skin pigmentation or hyperkalemia