Lecture 13: Adrenal Gland

Question 1

What are mineralocorticoids, glucocorticoids, and androgen estrogens synthesized from?

Answer 1

cholesterol

Question 2

What stimulates the release of cortisol from the adrenal cortex?

Answer 2

stress acting on the hypothalamus which eventually causes the pituitary gland to release ACTH to the adrenal cortex

Question 3

How is a dexamethasone suppression test performed?

Answer 3

low dose test- give .5mg dexamethasone every 6 hours for 8 doses

Question 4

What is the most useful test for adrenal insufficiency?

Answer 4

ACTH stimulation test

Question 5

What is a normal response for an ACTH stimulation test?

Answer 5

a cortisol level > 20 mg/dl

Question 6

How does an ACTH stimulation test work?

Answer 6

250 mg of Cortrosyn or Cosyntropin are given and serum cortisol is measured 60 minutes later

Question 7

What is an ACTH stimulation test result that is consistent with Addison’s disease?

Answer 7

pre ACTH cortisol is low and post ACTH cortisol is low

Question 8

What is CRH stimulation test used to differentiate?

Answer 8

primary and secondary adrenal insufficiency

Question 9

What are the CRH stimulation test results in primary adrenal insufficiency?

Answer 9

elevated ACTH but no cortisol production

Question 10

What are the CRH stimulation test results in secondary adrenal insufficiency?

Answer 10

low ACTH and Low cortisol

Question 11

What is the most important test to diagnose hyper and hypoaldosteronism?

Answer 11

aldosterone concentration

Question 12

how can aldosterone concentration be measured?

Answer 12

serum or urine

Question 13

What other test should be used besides aldosterone concentration when screening for primary aldosteronism?

Answer 13

renin activity level (PRA)

Question 14

What factors can affect aldosterone concentration?

Answer 14

potassium level, sodium level, inactivity, drugs

Question 15

What does plasma renin activity measure?

Answer 15

ability to convert angiotensinogen to angiotensin I

Question 16

What are elevated Plasma Renin Activity results seen in?

Answer 16

hyperaldosteronism

Question 17

What are signs ad symptoms of Cushing’s Syndrome?

Answer 17

rapid weight gain, moodiness, irritability, depression, muscle weakness, osteoporosis, diabetes mellitus, hypertension, immunosuppression, hair pattern changes, amenorrhea, infertility, buffalo hump, abdominal striae, adrenal tumor or hyperplasia, skin ulcers, poor wound healing

Question 18

What happens to the levels of ACTH in cushing’s syndrome

Answer 18

excess production of ACTH by pituitary

Question 19

What are the different types of cushing’s syndromes?

Answer 19

pituitary adenoma, ectopic ACTH, adrenal tumors, familial cushing’s, drug related

Question 20

What is step one for diagnosing cushing’s syndrome?

Answer 20

look for high cortisol level by taking 24 hour urine cortisol and salivary cortisol

Question 21

What is step two in diagnosing cushing’s syndrome?

Answer 21

finding the level of the problem; dexamethasone suppression test; CRH stimulation test to distinguish between pituitary and hypothalamus

Question 22

What is step 3 in diagnosing cushing’s syndrome?

Answer 22

looking for treatable causes by CT, MRI for tumors

Question 23

When should you check ACTH level for adrenal insufficiency?

Answer 23

when cortisol level is the highest (late morning)

Question 24

When is the best time to measure ACTH for cushing’s syndrome?

Answer 24

when cortisol is low (midnight to 2am)

Question 25

What is the most important test to diagnose hyper and hypoaldosteronism?

Answer 25

aldosterone concentration

Question 26

What are the causes for high cortisol?

Answer 26

taking steroids, diseases that cause excess cortisol, ACTH or CRH, tumors

Question 27

What are the cushing's syndromes?

Answer 27

pituitary adenomas, ectopic ACTH, adrenal tumors, familial, familial cushing's, drug related

Question 28

What are some clinical manifestations of ACTH Deficiency?

Answer 28

nausea, vomiting, weakness, fatigue, fever, hypotension

Question 29

What are some causes of a destruction of the adrenal cortex?

Answer 29

autoimmune disorders, tuberculosis, chronic infections

Question 30

What are some secondary causes for a lack of ACTH?

Answer 30

drugs, tumors and infections of pituitary gland

Question 31

What are two major things that are affected with a primary destruction of the adrenal cortex?

Answer 31

low cortisol and low aldosterone

Question 32

What differentiates Addison's disease?

Answer 32

aldosterone

Question 33

how does hypertension affect blood potassium?

Answer 33

it decreases blood potassium

Question 34

What happens when a person has low blood potassium?

Answer 34

tiredness, muscle weakness, polyuria

Question 35

What are some common causes of secondary hyperaldosteronism?

Answer 35

CHF, nephrotic syndrome, Cirrhosis

Question 36

What are the male symptoms of congenital adrenal hypoplasia?

Answer 36

``` Enlarged penis Failure to regain birth weight Weight loss Dehydration Vomiting Precocious puberty Rapid growth during childhood, but shorter than average final height. ```

Question 37

What are the female symptoms of congenital adrenal hypoplasia?

Answer 37

``` Ambiguous genitalia Failure to regain birth weight Weight loss Dehydration Vomiting Precocious puberty Rapid growth during childhood, but shorter than average final height. Infertility Irregular or absent menstruation Masculine characteristics ```