Adrenal gland disorders Flashcards
(23 cards)
N. meningitidis, sepsis, and septic shock all may cause ____
bilateral adrenal hemorrhage
What is the diagnostic test used to confirm suspected primary adrenal insufficiency?
Cosyntropin (ACTH) stimulation test
What initial tests should be performed in a patient with suspected adrenal insufficiency?
- Morning serum cortisol
- Plasma ACTH
- Cosyntropin (ACTH) stimulation test
Primary adrenal insufficiency can cause metabolic _____
acidosis
How do the following laboratory values change in primary adrenal insufficiency?
Cortisol
ACTH
Aldosterone
Cortisol: decreased
ACTH: increased
Aldosterone: decreased
Clinical features of primary adrenal insufficiency (Addison disease) include ___natremia, ___volemia, and ____kalemia, due to lack of mineralocorticoids
- hypo
- hypo
- hyper
Tertiary adrenal insufficiency is seen in patients with chronic exogenous glucocorticoid use, precipitated by:
Abrupt withdrawal
What is the level of ACTH in secondary adrenocortical insufficiency? Why?
Decreased; the disease is a result of decreased ACTH secretion
Treatment of adrenal insufficiency:
- Glucocorticoids for both primary and secondary
- Add fludrocortisone for primary (Addison disease)
Chronic excess levels of cortisol (glucocorticoid) result in _____ levels of CRH and ACTH via negative feedback
decreased
What is the most common endogenous cause of Cushing syndrome?
Cushing disease (i.e. an ACTH-secreting pituitary adenoma)
Congenital adrenal hyperplasia is a result of _____ levels of cortisol, causing ______ACTH secretion via loss of negative feedback
decreased
increased
If a patient with ACTH-dependent Cushing syndrome has adequate cortisol suppression following a high-dose dexamethasone suppression test (8mg), the most likely cause of their syndrome is:
Cushing disease
If a patient with ACTH-dependent Cushing syndrome has no cortisol suppression following a high-dose dexamethasone suppression test (8mg), the most likely cause of their syndrome is:
Ectopic ACTH secretion
What is the differential diagnosis in a patient with Cushing syndrome with elevated ACTH?
- Cushing disease (ACTH-secreting pituitary adenoma)
- Ectopic ACTH secretion
What is the management for postadrenalectomy syndrome (Nelson syndrome: enlargement of existing ACTH-secreting pituitary adenoma after bilateral adrenalectomy)?
Radiotherapy of the pituitary
What is the differential diagnosis in a patient with Cushing syndrome with suppressed ACTH?
- Exogenous glucocorticoids
- Adrenal adenoma (or carcinoma, hyperplasia)
Postadrenalectomy syndrome (Nelson syndrome) presents with symptoms of both mass effect and elevated ACTH, including:
Hyperpigmentation, headaches, and bitemporal hemianopsia
Work-Up pheochromocytoma :
1) ↑ 24-hour urine catecholamines and metanephrines followed by:
2) Adrenal CT/MRI* to localize tumor
3) I-123 MIBG scan that is taken up by tumor
Prior to removal of a pheochromocytoma _____ are administered, followed by_____
- α-antagonists, such as phenoxybenzamine
- β-blockers
What is the most common tumor that produces ectopic ACTH?
Small cell lung carcinoma (SCLC)
4 S’s of adrenal crisis management:
- Salt: 0.9% NaCl
- Steroids: IV hydrocortisone
- Support: Hemodynamic, glucose
- Search for the underlying illness
5 P of pheochromocytoma
- Pressure HTN
- Pain- headache
- Perspiration
- Palpitations
- Pallor
