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Y3R5: Medicine I 🩺 > L11: Adrenal Gland Disorders > Flashcards

L11: Adrenal Gland Disorders Flashcards

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1
Q

Revise Introduction from notes

A

First 2 Pages

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2
Q

Def of Cushing Syndrome

A
  • A diverse symptom complex resulting from excess steroid hormone production by the adrenal cortex (endogenous) or to sustained administration of
    glucocorticoids (exogenous)
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3
Q

what is Cushing Disease?

A

refers to → over secretion of ACTH from a pituitary adenoma

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4
Q

Causes of Cushing Syndrome

A
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5
Q

Causes of ACTH independent Cushing

A
  • Overproduction of glucocorticoids may be due to an adrenal adenoma, adrenal carcinoma, or adrenal hyperplasia
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6
Q

what is the most common cause of Cushing Syndrome?

A

Exogenous glucocorticoid intake (Iatrogenic Cushing)

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7
Q

ACTH dependent Cushing by pituitary adenoma

A

Pituitary adenomas that secrete ACTH are derived from corticotroph cells in the anterior pituitary.

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8
Q

Obesity

  • Cushing Syndrome
A

 Generalized obesity in addition to centripetal (truncal) obesity

 Moon facies

 Buffalo hump

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8
Q

Cushing syndrome due to Ectopic Secretion

A
  • Ectopic ACTH secretion is caused by small-cell lung tumors, carcinoid tumors
  • Ectopic CRH secretion leading to increased ACTH secretion comprises a very rare group of cases of Cushing syndrome.
  • Ectopic cortisol secretion from a case of ovarian carcinoma.
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9
Q

CP of Cushing Syndrome

A
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10
Q

Reproductive dysfunction

  • Cushing Syndrome
A

 Gonadal dysfunction with menstrual irregularity in females and loss of libido in both sexes

 Hirsutism

 Acne

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11
Q

Psychiatric abnormalities

  • Cushing Syndrome
A
  • Agitated depression
  • Overt Psychosis
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12
Q

Bone

  • Cushing Syndrome
A

Generalized osteoporos

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13
Q

Skin

  • Cushing Syndrome
A
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14
Q

what causes increased skin pigmentation in Cushing Syndrome?

A

Increased skin pigmentation d2 overstimulation of melanocyte receptors by ACTH (only in ACTH dependent Cushing)

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15
Q

Muscle

  • Cushing Syndrome
A

Myopathy

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16
Q

CVS

  • Cushing Syndrome
A
  • Hypertension
  • Together with other metabolic derangement, as diabetes, may lead to increased mortality
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17
Q

Infection

  • Cushing Syndrome
A

 Fungal infections
 Reactivation of TB
 Wound infection and impaired healing

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18
Q

Investigations for Cushing Syndrome

A

Lab:
- Confirmation of hypercortisolism
- Differentiation of Cushing Syndrome
- In addition to others

Rad:
- Pituitary MRI with contrast
- Abdominal (Suprarenal) CT
- Chest X-Ray or CT

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18
Q

Eye

  • Cushing Syndrome
A

 Cataract
 Raised intra ocular pressure
 Exophthalmos because of increased retro orbital fat

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19
Q

Metabolic & Endocrine

  • Cushing Syndrome
A

 Impaired glucose tolerance or Diabetes Mellitus
 Hypokalemic alkalosis
 Hypogonadotropic Hypogonadism (reversible)
 Water retention

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20
Q

Confirmation of hypercortisolism

  • Cushing Syndrome
A
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21
Q

Rad Dx of Cushing Syndrome

A

 Pituitary MRI with contrast : For pituitary adenoma
 Abdominal (Suprarenal) CT : For adrenal causes
 Chest X-Ray or CT : For ectopic Cushing

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22
Q

Diffrentiation of Cushing Syndrome

  • Cushing Syndrome
A
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23
IPSS - **Cushing Syndrome**
24
TTT of **Cushing Syndrome**
25
Medical TTT of **Cushing Syndrome**
25
Surgical TTT of **Cushing Syndrome**
26
Irradiation therapy of **Cushing Syndrome**
- Irradiation of the pituitary could be reverted to when Trans-sphenoidal surgery is not successful or not possible. - Late-onset adverse effects include hypopituitarism
27
Post-Operative Managment of **Cushing Syndrome**
Clearly, if both adrenals are removed, replacement with prednisolone is a lifelong treatmen
28
Nelson's Syndrome
29
Causes of **Pseudo-Cushing Syndrome**
30
Def of **Pseudo-Cushing Syndrome**
Group of reversible disorders with subtle symptoms and signs of Cushing’s syndrome and hypercortisolism with defective response to dexamethasone suppression tests.
31
Def of **Cyclical Cushing Syndrome**
32
These patients require frequent monitoring with urine free cortisol or late-night salivary cortisol to establish the diagnosis, as cycle length varies from days to months. - **Cyclical Cushing Syndrome**
..
33
Inadequate cortisol in times of stress can lead to ..........
hypotension, shock, and hypoglycemia
34
......... deficiency typically leads to renal wasting of sodium, retention of potassium, and reduced intravascular volume.
Mineralocorticoid
35
Types of **Suprarenal Failure (Adrenal Insufficiency)**
36
what is addison's disease?
- Is an uncommon disorder that occurs when body doesn't produce enough of certain hormones. - In Addison's disease, adrenal glands produce too little cortisol and too little aldosterone
37
Def of **Addison's disease**
- Is an uncommon disorder that occurs when body doesn't produce enough of certain hormones. - In Addison's disease, adrenal glands produce too little cortisol and too little aldosterone
38
Causes of **Addison's disease**
39
What is the most common cause of **Addison's disease** in developed countries?
Autoimmune disease is the most common cause in developed countries (90%)
40
Symsptoms of **Addison's disease**
41
What is the most common cause of **Addison's disease** in developing countries?
Tuberculosis (<10%) most common cause in developing countries
42
DDx of hyperpigmentation
43
Dx of **Addison's disease**
44
Blood tests in Dx of **Addison's disease**
45
ACTH stimulation test in **Addison's disease**
45
Hx in Dx of **Addison's disease**
Dark patches on skin might be a clue to consider testing for Addison's disease
46
X-Rays in Dx of **Addison's disease**
Calcium deposits on the adrenal glands
47
TTT of **Addison's disease**
48
CT in Dx of **Addison's disease**
Adrenals and/or pituitary gland.
49
Difference between 1ry & 2ry Adrenal insufficiency
49
Causes of **Secondary Adrenal Insufficiency**
50
Causes of **Acute Hypoadrenalism (Addisonian Crisis)**
51
CP of **Acute Hypoadrenalism (Addisonian Crisis)**
52
INVx for **Acute Hypoadrenalism (Addisonian Crisis)**
 Plasma cortisol < 5 mcgm  Hypoglycemia  Hyponatremia  Hyperkalemia
53
DDx of **Acute Hypoadrenalism (Addisonian Crisis)**
 Hypotension resistant to vasopressor agents  Medical cause of acute abdomen  PUO ( pyrexia of unknown origin )  D.D of underlying etiology
54
Read Power Questions from notes
pages 18 & 19
55
TTT of **Acute Hypoadrenalism (Addisonian Crisis)**
56
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Y3R5: Medicine I 🩺 (47 decks)

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