Adrenal Gland Disease

Question 1

what is adrenal medulla innervated by

Answer 1

sympathetic and parasympathetic cholinergic nerve fibers

Question 2

adrenal medulla produces and releases

Answer 2

catecholamines

Question 3

zona glomerulosa produces

Answer 3

mineralocorticoids (aldosterone)

Question 4

zona fasciculata produces

Answer 4

glucocorticoids (cortisol)

Question 5

ACTH and cortisol levels peak and trough

Answer 5

highest in morning, low in PM (midnight)

Question 6

zona reticularis produces and secretes

Answer 6

androgens (gonadocorticoids)

Question 7

main androgen produced by adrenal cortex

Answer 7

DHEA

Question 8

androgen secretion regulated by

Answer 8

ACTH rather than gonadotropins

Question 9

CRH levels normal

Answer 9

1-10 pg/mL

Question 10

ACTH levels normal

Answer 10

10-60 pg/ml at 8 am. values decrease throughout the day.

Question 11

when to check ACTH or cortisol levels when suspect adrenal insufficiency

Answer 11

AM, levels should be high

Question 12

when to check ACTH or cortisol levels when suspect hypercortisolism,

Answer 12

PM, when levels should be lowest

Question 13

serum total cortisol normal levels

Answer 13

10-20 mcg/dL in AM. afternoon- 3 to 10 mcg/dL. Lowest at night- less than 5 mcg/dL

Question 14

what test to order if want to measure FREE cortisol levels

Answer 14

24 hour urine free cortisol levels or salivary cortisol levels

Question 15

cosynotropin

Answer 15

(high dose)250 mcg given in ACTH stimulation test (when adrenal insufficiency suspected)

Question 16

ACTH stimulation test

Answer 16

administer 250 mcg cosynotropin. Measure serum cortisol levels before and 30 and 60 min after administration. Cortisol should be at high levels after. But if adrenal insufficiency, will have low levels.

Question 17

test ordered if suspect cushing’s syndrome

Answer 17

CRH stimulation test

Question 18

test to order if suspect adrenal hyperfunction (hypercortisolism)

Answer 18

dexamethasone suppression test

Question 19

low dose vs. high dose dexamethasone suppression test

Answer 19

low dose- 1 mg. high dose- 8 mg

Question 20

pituitary or adrenal tumors more common?

Answer 20

pituitary

Question 21

sx highly suggestive of hypercortisolism

Answer 21

supraclavicular fat pads, skin atrophy, wide purplish striae, central obesity “Moon face” or “buffalo hump”, bruises, fungal infections

Question 22

hyperpigmentation in cushing’s caused by…

Answer 22

ACTH dependent cause, like cushing’s disease, ectopic ACTH production, ectopic CRH production

Question 23

what is most common type of adrenal insufficiency

Answer 23

secondary/tertiary

Question 24

etiology of primary adrenal insufficiency

Answer 24

autoimmune disease

Question 25

priamry adrenal insufficiency affects...

Answer 25

adrenal gland disease. = decreased levels of aldosterone, cortisol, and androgens

Question 26

secondary/tertiary adrenal insufficiency affects

Answer 26

pituitary or hypothalamus disease - decreased levels of cortisol and androgens. normal levels of aldosterone

Question 27

hyperpigmentation, dehydration, hyperkalemia present in which adrenal insufficiency

Answer 27

primary

Question 28

ACTH levels in adrenal insufficiency

Answer 28

primary- levels increased. secon/tertiary- levels LOW.

Question 29

acute adrenal crisis can occur in

Answer 29

adrenal insufficiency

Question 30

adrenal insufficiency dx

Answer 30

AM serum or salivary cortisol levels, short ACTH stimulation test. Measure plasma ACTH, renin, and aldosterone. CRH test, insulin induced hypoglycemia test

Question 31

cushing's syndrome dx

Answer 31

24 hour urinary cortisol excretion elevated, serum cortisol elevated in PM, salivary cortisol elevated PM, low dose dexamethasone suppression test. 2. determine etiology. ACTH levels. ACTH- independent, CT imaging of adrenal gland. ACTH- dependent: high dose dexamethasone suppression test or CRH stimulation test