Adrenal Path-Usera Flashcards
What are the 3 parts of the adrenal cortex? What does each secrete?
Capsule (GFR)
Zona Glomerulosa-mineralcorticoids, aldosterone
Zona Fasciculata-glucocorticoids-cortisol
Zona Reticularis-sex hormones
What is the adrenal medulla derived from? What does it secrete?
neural crest cells
catecholamines, like NE, Epi
Describe how tyrosine becomes catecholamines?
Tyrosine–>DOPA–>dopamine->NE–>Epi
What are 3 forms of adrenocortical insufficiency?
Acute adrenocortical insufficiency
Chronic adrenocortical insufficiency (Addison’s disease)
Adrenogenital syndrome (congenital adrenal hyperplasia)
What can cause acute adrenocortical insufficiency?
Abrupt withdrawal of corticosteroids
Adrenal Hemorrhage–
1.Anticoagulation therapy
2.Waterhouse-Friderichsen syndrome
What is waterhouse friderichsen syndrome?
bilateral adrenal hemorrhage
associated with neisseria meningitidis sepsis
endotoxic shock with DIC
**can cause acute adrenocortical insufficiency
80% of chronic adrenocortical insufficiency cases are ______.
autoimmune
Other causes of chronic adrenocortical insufficiency?
INfectious–TB, histoplasmosis
metastatic cancer (from lung or renal cell carcinoma)
AIDS
adrenogenital syndrome
What are the clinical findings in chronic adrenal insufficiency?
weakness
hypotension
hyperpigmentation (from too much POMC released w/ ACTH)
What are the lab findings for chronic adrenal insufficiency?
Hyponatremia-no aldosterone Hyperkalemia Metabolic acidosis (normal anion gap)
Other findings in chronic adrenal insufficiency?
Fasting hypoglycemia Lymphocytosis, eosinophilia, neutropenia Increased acth No response to acth stimulation test
Why do you see hypoglycemia and eosinophilia in chronic adrenal insufficiency?
cortisol released from adrenal cortex is gluconeogenic & sequesters eosinophils in lymph nodes.
W/o this–>hypoglycemia & lots of eosinophils in the blood stream.
Once again, why is there hyponatremia, hyperkalemia, and metabolic acidosis with chronic adrenal insufficiency?
Aldosterone causes you too keep Na+, get rid of K+ and get rid of some H+.
W/o it: hyponatremia, hyperkalemia, metabolic acidosis
What is the metyrapone test?
Inhibits 11ß-hydroxylase and prevents cortisol synthesis
Should result in acth secretion and ↑steroid precursors
↑Acth and no increase in 11-deoxycortisol indicates adrenal insufficiency
What causes adrenogenital syndrome/congenital adrenal hyperplasia?
aut rec disorders of enzymes
21-hydroxylase deficiency
11-hydroxylase deficiency
17-hydroxylase deficiency
Which ones of the enzyme deficiencies is the most common cause of adrenogenital syndrome? 90-95% of cases?
21-hydroxylase deficiency
Which enzyme deficiency causes hypogonadism w/ adrenogenital syndrome?
17-hydroxylase deficiency
What happens in adrenogenital syndrome?
Causes ↑acth, and accumulation of precursors proximal to enzyme block
Increased 17-ketosteroids
testosterone
What is the presentation of 21-hydroxylase and 11-hydroxylase deficiency?
Precocious puberty in males, and females
Rapid growth as children, but short stature as adults
What is the presentation of 17-hydroxylase deficiency?
Decrease in Glucocorticoids and androgens
“salt retainers” -b/c still have aldosterone
Females: delayed menarche and 2˚ sexual characteristics
Males: “pseudohermaphroditism”
What are some examples of adrenocortical hyper function?
Cushing Syndrome
Hyperaldosteronism (Conn’s Syndrome)
What are some things that can cause Cushing Syndrome?
Cushing Disease–ACTH secreting pituitary adenoma
prolonged corticosteroid use
hyperfunctional adrenal adenoma
ectopic ACTH production
What is involved in Cushing’s syndrome?
moon facies buffalo hump easy bruising abdominal weight gain striae (weakened collagen, rupture bv) hirsutism (increased androgens) diastolic HTN (increased mineral corticoids) weakness
Why the weight gain in Cushing’s syndrome?
Hyperinsulinism 2˚ to hyperglycemia
