Disorders of the Adrenal Gland Flashcards Preview

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Flashcards in Disorders of the Adrenal Gland Deck (59)
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1

What does the adrenal gland produce?

Steroids (glucocorticoids, mineralcorticoids and androgens/DHEA) and catecholamines

2

What is produced in the zona glomerulosa?

Mineralocorticoids (aldosterone-regulate salt balance and blood vol)

3

What is produced in the zona fasciculata?

Glucocorticoids (cortisol-increase blood glucose, metabolism)

4

What is produced in the zona reticularis?

Androgens (DHEA-converted into testosterone, DHT and estradiol)

5

What is produced in the adrenal medulla?

Catecholamines (increase BP, respiration, HR, constrict BF to GI tract)
PNS regulates

6

Functions of cortisol

Stimulate gluconeogenesis (increase blood glucose)
Decrease glucose uptake by tissues
Promote anti-inflammatory effects
Reduce bone formation
Increase proteolysis in muscle
Maintains normal BP
Decrease intestinal and renal Ca absorption, decreasing plasma Ca
Inhibit collagen formation

7

When is cortisol release the highest?

Morning

8

What does Cushing's syndrome result from?

Prolonged exposure to excess glucocorticoids and androgens

9

Main features of Cushing's syndrome

Amenorrhea
Adrenal androgen excess (hirsutism, ance, libido)
Striae
Hyperpigmentation
Central obesity (moon face, buffalo hump)
HTN

10

2 etiologies of Cushing's syndrome

ACTH dependent (mostly)
ACTH independent

11

Etiologies of ACTH dependent Cushing's syndrome

Cushing's disease (pituitary hypersecretion of ACTH)
Ectopic secretion of ACTH by non-pituitary tumor
Other

12

Etiologies of ACTH independent Cushing's Syndrome

Iatrogenic or factitious Cushing's syndromes (administer excessive synthetic glucocorticoid)
Adrenocortical adenomas and carcinomas
Others (pheochromocytoma)

13

How to distinguish b/w ACTH dependent and independent Cushings?

Dependent: cortisol is high and ACTH is high, more females
Independent: cortisol high and ACTH low

14

How to diagnose Cushing's syndrome

Exclude exogenous glucocorticoids
Gold standard: 24 hr urinary free cortisol excretion
Late night salivary cortisol
Low dose dexamethasone suppression tests

15

What is the low-dose dexamethasone suppression test?

1 mg oral dose of dexamethasone administered at 11 pm and then serum cortisol levels are measured at 8 am the next day

16

Abnormal dexamethasone suppression test

Elevated cortisol above 5 mcg/dL

17

What are you suspicious for with an abnormal dexamethasone suppression test?

Non-suppressible cortisol production from ACTH independent etiology

18

Other tests to diagnose Cushing's syndrome

MRI (for pituitary tumor)
CXR (r/o lung masses as source of tumor)
Pelvic u/s (rule out ovarian mass)
CT abdomen (evaluate for adrenal tumor)

19

Management of Cushing's syndrome due to exogenous corticosteroids

Taper to lowest therapeutic dose to control sxs

20

Management of Cushing's syndrome due to a pituitary adenoma

Transsphenoidal resection

21

Management of Cushing's syndrome due to adrenal tumor

Adrenalectomy

22

Management of Cushing's syndrome due to adrenal hyperplasia, inoperable tumor or other malignancy

Medical therapy is warranted

23

1st line med for Cushing's syndrome

Ketoconazole (add metyrapone if ineffective)

24

What can mitotane be used for?

Medical adrenalectomy

25

Functions of aldosterone

Increase BP
Increase ECF vol
Increase tubular reabsorption of sodium
Promote excretion of potassium
Water retention

26

Most common etiologies of Conn's syndrome (primary hyperaldosteronism)

Bilateral idiopathic adrenal hyperplasia
Unilateral aldosterone-producing adenoma

27

Features of Conns

HTN and hypokalemia
(muscle weakness, paresthesias, HA, polyuria, polydipsia)

28

Who do you want to consider testing for Conns?

HTN and hypokalemia
Resistant HTN (3 drugs and poor BP control)
Adrenal incidentaloma and HTN
Onset of HTN at young age
Severe HTN (>150 SBP or >100 DBP)
When considering secondary HTN

29

What is a CT used for in Conns?

Evaluate for possible adrenal adenoma

30

Management for unilateral adrenal adenoma

Surgical removal