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Week 27: Adrenal Dysfunction > Clinical Syndromes of ACTH > Flashcards

Flashcards in Clinical Syndromes of ACTH Deck (18)
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1

Cushing syndrome vs disease

Syndrome: chronic GC excess
Disease: specific type of Cushing syndrome due to excessive pituitary ACTH secretion from a pituitary tumor

2

3 ways to classify Cushing syndrome

ACTH-dependent
ACTH-independent
Pseudo-Cushing syndrome

3

Clinical features of Cushing syndrome

Obesity
HTN
Skin: Plethora, hirsutism, striae, acne, bruising
MSK: osteopenia, weakness
Neuropsychiatric: emotional lability, euphoria, depression, psychosis
Gonads: menstrual disorders, impotence, decreased libido
Metabolic: glucose intolerance, diabetes, hyperlipidemia, polyuria, kidney stones

4

3 steps in diagnosis Cushing syndrome

Clinical suspicion
Confirmation of hypercortisolism
Localization of the cause

5

3 tests to confirm hypercortisolism

1 mg overnight dexamethasone suppression test
Measurement of 24hr UFC in 2 or 3 collections (urine)
Measurement of midnight salivary cortisol levels

6

2 tests for DDx of ACTH-dependent Cushing's syndrome

Cranial MRI study
Bilateral simultaneous inferior petrosal sinus ACTH sampling

7

1 test for DDx of ACTH independent Cushing's syndrome

Abdominal MRI or CT scan

8

Treatment of Cushing Syndrome

Surgery: pituitary, ectopic, adrenal
Medical: ketoconazole, metyrapone

9

Adrenal insufficiency definition

Clinical condition that results from deficient production or action of GCs
With or without deficiency in mineralocorticoids and adrenal androgens

10

Most common cause of primary adrenal insufficiency

Autoimmune adrenalitis (Addison's)

11

3 general causes of secondary adrenal insufficiency

Space occupying lesion or trauma
Genetic disorders
Drugs (long term GC use is the most common cause)

12

Causes of tertiatry adrenal insufficiency

Hypothalamic tumours
Hypothalamic surgery/irradiation
Infections or infiltrative processes
Trauma, injury

13

Common signs/symptoms of adrenal insufficiency

Fatigue, lack of energy or stamina, reduced strength
Anorexia, weight loss
Gastric pain, nausea, vomiting
Skin hyperpigmentation
Low BP, postural hypotension, dehydration

14

Clinical features of acute adrenal crisis

Fever
Nausea, vomiting, anorexia
Weakness, apathy, depressed mentation
Hypoglycemia
Dehydration, volume depletion
Hypotension and shock

15

3 main aims in the diagnosis of adrenal insufficiency

To confirm inappropriately low cortisol secretion
To find out whether the adrenal insufficiency is primary or central
To delineate the underlying pathological process

16

Insulin Tolerance test (insulin induced hypoglycemia)

Useful in patients with suspected corticotropin deficiency of recent origin
Tests the whole HPA axis (gold standard)
Give insulin, measure cortisol every 30 mins for at least 2 hours

17

Acute treatment for adrenal insufficiency

General and supportive measures (correct volume depletion/hypoglycemia)
GC replacement
Mineralocorticoid replacement (only in primary adrenal insufficiency)

18

Chronic treatment for adrenal insufficiency

GC replacement
Mineralocorticoid replacement
Adrenal androgen replacement
Education