[M6] Part 3: Adrenal Gland Flashcards by Marlo Roque

Multifunctional organ that produces hormones or substances that are essential for life.

ADRENAL GLAND

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It is a pyramidal/pyramid-like shaped endocrine gland, located ___ and ___ to the ___

ADRENAL GLAND;
superior (upper) ;
medial (middle) ;
kidneys

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Composed of 2 conjoined glands:

ADRENAL GLAND

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WHAT ARE THE 2 CONJOINED GLANDS OF ADRENAL GLAND

Adrenal cortex
Adrenal medulla

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Outer part of the adrenal gland.

ADRENAL CORTEX

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90% of total adrenal gland

ADRENAL CORTEX

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ADRENAL CORTEX is ___ of total adrenal gland

90%

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ADRENAL CORTEX In cross section: ____

yellowish in color

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Major site of steroid hormone production

ADRENAL CORTEX

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ADRENAL CORTEX is the Major site of ___

steroid hormone production

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ADRENAL CORTEX is Derived from __

mesenchymal cells

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Derived from mesenchymal cells

ADRENAL CORTEX

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Composed of 3 zones with distinct tissues.

ADRENAL CORTEX

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3 ZONES OF ADRENAL CORTEX

G-ZONE
F-ZONE
R-ZONE

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Outer part zone of Adrenal cortex

G-ZONE

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10% of the total adrenal cortex

G-ZONE

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G-ZONE is AKA

zona glomerulosa

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G-ZONE
Hormone produced: __

aldosterone

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aldosterone is a ___

mineralocorticoid

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regulates sodium which is an electrolyte

aldosterone

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75% of the total adrenal cortex

F-ZONE

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F-ZONE is AKA

zona fasciculata

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AKA zona fasciculata

F-ZONE

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F-ZONE
Hormone produced: ____

glucocorticoids

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F-ZONE produces glucocorticoids hormones such as ___ and ____

cortisol and cortisone

Example of glucocorticoids

cortisol and cortisone

stored form of cortisol

cortisone

F-ZONE Also produces ____

adrenal androgens

Example of adrenal androgens produced by the F-ZONE

dehydroepiandrosterone (DHEA)

DHEA stands for

dehydroepiandrosterone (DHEA)

precursor for other sex androgens/sex hormones (active androgens)

dehydroepiandrosterone (DHEA)

15% of the total adrenal cortex

R-ZONE

R-ZONE is aka

zona reticularis

AKA zona reticularis

R-ZONE

R-ZONE FUNCTION

It sulfates DHEA

R-ZONE sulfates DHEA by the Addition of ____ to the ____ forming ____ (___)

sulfate ; DHEA ; sulfated DHEA ; DHEAS

Purpose of DHEAS

serves as the major precursor for active androgens and estrogen

DHEAS

main adrenal androgen

DHEAS

CRH stands for

corticotropin-releasing hormone

Main regulator of Adrenal cortex

(CRH)

the production is in response to three factors

corticotropin-releasing hormone (CRH)

3 factors involved in the production of CRH

Low cortisol level Stress Circadian Rhythm

CRH: Circadian Rhythm What is the peak conc.

6am-8am

CRH: Circadian Rhythm What is the Lowest conc.

10pm-12mn

REGULATION: 1. CRH which is produced by the ____, will stimulate the ____ to secrete ____

hypothalamus; pituitary gland ACTH.

REGULATION: 2. ACTH will stimulate the ____ to produce ___.

adrenal cortex; Steroid hormones

T/F: all hormones produced by the adrenal cortex is steroid

all hormones produced by the adrenal cortex is ___

steroid

In order to produce steroid hormones, kailangan niya ng ____.

precursor

main precursor for steroid hormones

Cholesterol

REGULATION: 3. ACTH will stimulate the ___ of ____ inside the ____ of adrenal cortex

transport ; cholesterol ; mitochondria

REGULATION: 4. when the cholesterol is inside the mitochondria, it will undergo the process ____

steroidogenesis

process that involves the production of steroid hormone

steroidogenesis

REGULATION: 5. First product produced: ____

pregnenolone

serves as a substrate for all adrenal cortex hormones

pregnenolone

REGULATION: 6. The production of the adrenal cortex hormone is influenced by the ____

negative feedback system.

↓cortisol = ___CRH

increased ↑CRH

REGULATION: 6. However, ____ (inc/dec) cholesterol do not stimulate the ___ (produces aldosterone)

↓cholesterol; G-ZONE

REGULATION: 7. Remember that aldosterone is _____ by ____level bec. aldosterone production is only stimulated by the ____

not influenced ; cortisol ; renin-angiotensin aldosterone system (RAAS)

RAAS = activates when there is a ____

↓BV, ↓BP

RAAS = activates when there is a ____

↓BV, ↓BP

↓cortisol = ____ CRH and ACTH

increases

T/F: ↓cortisol = ↑CRH and ACTH but HINDI tataas si aldosterone

G-ZONE will only produce aldosterone in response to ____

↓BV, ↓BP

Kidney produces ___

renin

(stimulates the production of aldosterone by the G-ZONE

renin

adrenal cortex hormone synthesis

Steroidogenesis

Before adrenal cortex hormones are produced, kailangan ng ___.

cholesterol

promotes entry of cholesterol to the mitochondria of adrenal cortex

ACTH

STEROIDOGENESIS: 1. Cholesterol will be converted to ___ by the enzyme _____

pregnenolone ; cytochrome p450

Conversion of cholesterol to pregnenolone occurs in ___

mitochondria

STEROIDOGENESIS: 2. Once the pregnenolone is produced in the mitochondria, it will be released in the ___/___.

cytosol ; cytoplasm

this is where the further conversion of pregnenolone to various adrenal cortex hormones.

Cytoplasm

STEROIDOGENESIS: 3. In the ____, pregnenolone in the cytosol may migrate to the ____/___

G-ZONE F-ZONE ; R-ZONE

STEROIDOGENESIS: 4. In the G-ZONE, it will be converted to ____(only produce in response to ___)

aldosterone ; RAAS

STEROIDOGENESIS: 5. Pregnenolone will be converted to ____ in the presence of__________

17α-OH pregnenolone ; 17-OH ase enzymes

17-OH ase enzymes is also known as what in other books

17α-OH ase

STEROIDOGENESIS: 6._____ in the____, will be converted to form ___ and further to ____

17α-OH ase; F-ZONE; cortisol; cortisone

Cortisol is produced in response to ___ and ___

CRH ACTH

STEROIDOGENESIS: 7. The ____ in the ___ may migrate to the ___ to form ___ in the presence of the same enzyme (____).

17-OH pregnenolone; F-ZONE ; R-ZONE ; DHEA ; 17- hydroxylase

Associated with absence or deficiency in the enzyme required for steroidogenesis.

CONGENITAL ADRENAL HYPERPLASIA (CAH)

Inherited family of enzyme disorders

CONGENITAL ADRENAL HYPERPLASIA (CAH)

enzyme required for steroidogenesis.

3ß-hydroxysteroid isomerase 17α-hydroxylase 11ß-hydroxylase 21ß-hydroxylase

CONGENITAL ADRENAL HYPERPLASIA (CAH) __ (inc/dec) cortisol and aldosterone production

Decreased

Clinical presentation depends on the enzyme affected

CONGENITAL ADRENAL HYPERPLASIA (CAH)

Types of CONGENITAL ADRENAL HYPERPLASIA (CAH)

3ß-hydroxysteroid isomerase 17α-hydroxylase 11ß-hydroxylase 21ß-hydroxylase

Hypertension: No Virilization: Slight

3ß-hydroxysteroid isomerase

High Laboratory Value for 3ß-hydroxysteroid isomerase

DHEA

Hypertension: Yes Virilization: No

17α-hydroxylase

High Laboratory Value for 17α-hydroxylase

Aldosterone

Hypertension: Yes Virilization: Marked

11ß-hydroxylase

High Laboratory Value for 11ß-hydroxylase

11-deoxycorticosterone

Hypertension: No Virilization: Marked

21ß-hydroxylase

High Laboratory Value for 21ß-hydroxylase

17-hydroxyprogesterone

development of masculine physical traits among women

Virilization

Example of Virilization

hirsutism

hairy women; usually seen in px with PCOS

hirsutism

Most potent mineralocorticoid

ALDOSTERONE

electron regulating hormones

Mineralocorticoid:

Increase blood pressure through volume expansion by increasing sodium reabsorption

ALDOSTERONE

Stimulates H+and K+ excretion

ALDOSTERONE

ALDOSTERONE Stimulates ____ and ___ excretion

H+ K+

It is unique among the adrenal cortex hormones

ALDOSTERONE

ALDOSTERONE is unique among the adrenal cortex hormones because aldosterone production is not stimulated by ___ and ___

CRH ; ACTH

ALDOSTERONE is stimulated by the ___

RAAS

RAAS is stimulated by ___ or ___

decreased blood pressure; blood volume

↓ blood volume/pressure = the ___, specifically the ____ (JG) cells of the ____, will secrete ___

kidneys; juxtaglomerular ; nephrons; renin

Renin will convert ___ to ____

angiotensinogen ; angiotensin I

Angiotensin I is further converted to angiotensin II by the enzyme____which is produced by the ____

angiotensin converting enzyme (ACE) ; lungs

Functions of angiotensin II: 1. Stimulate the ____ to produce ___ which will then promote ____ in the________ 2. It will also stimulate the ___ to produce ____ which will promote ____ in the ____ 3. It can also ___ (INC/DEC) ___ by causing ____ 4. It can also __ (INC/DEC) ____ in the ____

1. adrenal cortex ; aldosterone; sodium reabsorption ; distal convoluted tubules (DCT) 2. hypothalamus ; vasopressin ; water resorption; collecting duct 3. INCREASE; arterial pressure ; vasoconstriction 4. INCREASE; sodium reabsorption ; proximal convoluted tube (PCT)

ADLOSTERONE SECRETION Stimulated by:

Low Blood Pressure Angiotensin II ACTH Elevated serum K+ Progesterone Dopamine

ALDOSTERONE SECRETION (Stimulated) Main stimulant

Low Blood Pressure

ALDOSTERONE SECRETION (Stimulated) Angiotensin II

Low Blood Pressure

ALDOSTERONE SECRETION (Stimulated) Only stimulates aldosterone production by stimulating the entry of cholesterol in the G-ZONE

ACTH

ALDOSTERONE SECRETION (Stimulated) It does not directly stimulate the production aldosterone

ACTH

ALDOSTERONE SECRETION Inhibited by:

Atrial Natriuretic Peptide Intracellular calcium Certain drugs:

ALDOSTERONE SECRETION (Inhibited) What certain drugs inhibit Aldosterone Secretion?

Ketoconazole ACE inhibitors NSAIDs Heparin

Meaning of NSAIDS

Nonsteroidal anti-inflammatory drugs

Example of NSAIDS

Ibuprofen

Also termed as primary aldosteronism in some books

Primary Hyperaldosteronism

Primary Hyperaldosteronism is also termed as ______ in some books

primary aldosteronism

PRIMARY HYPOALDOSTERNISM a.k.a.

Conn’s disease

PRIMARY HYPOALDOSTERNISM Caused by:

Aldosterone-secreting adrenal adenoma Unilateral/Bilateral adrenal hyperplasia Familial hyperaldosteronism Adrenocortical carcinomas Ectopic aldosterone production

PRIMARY HYPOALDOSTERNISM CAUSED BY Autonomous aldosterone production due to the presence of adenoma and hyperplasia

Aldosterone-secreting adrenal adenoma Unilateral/Bilateral adrenal hyperplasia

PRIMARY HYPOALDOSTERNISM CAUSED BY Genetic defect, hereditary

Familial hyperaldosteronism

PRIMARY HYPOALDOSTERNISM CAUSED BY Associated with carcinoma that produces ACTH

Adrenocortical carcinomas

PRIMARY HYPOALDOSTERNISM CAUSED BY May nagpo-produce ng aldosterone aside from the adrenal cortex

Ectopic aldosterone production

PRIMARY HYPOALDOSTERNISM Increased

plasma aldosterone

PRIMARY HYPOALDOSTERNISM Decreased

plasma renin

Occurs as a result of excess production of renin

Secondary Hyperaldosteronism

SECONDARY HYPERALDOSTERONISM Increased

aldosterone and renin

Also known as Liddle’s syndrome

PSEUDOHYPERALDOSTERONISM

PSEUDOHYPERALDOSTERONISM a.k.a

Liddle’s syndrome

PSEUDOHYPERALDOSTERONISM There are varying levels in ____and ___

renin aldosterone

PSEUDOHYPERALDOSTERONISM T/F: Most cases have low aldosterone

PSEUDOHYPERALDOSTERONISM Most cases have low aldosterone except for:

Bartter’s Syndrome Gitelman’s Syndrome

PSEUDOHYPERALDOSTERONISM bumetanide-sensitive chloride channel mutation

Bartter’s Syndrome

PSEUDOHYPERALDOSTERONISM thiazide-sensitive transporter mutation

Gitelman’s Syndrome

PSEUDOHYPERALDOSTERONISM Both Bartter’s syndrome and Gitelman’s syndrome show an (inc/dec) in aldosterone

Increase

Both Bartter’s Syndrome and Gitelman’s Syndrome are _____ associated

drug associated

Due to destruction of adrenal glands and deficiency of glucocorticoid

ISOLATED HYPOALDOSTERONISM

ISOLATED HYPOALDOSTERONISM Due to destruction of ____ and deficiency of _____

adrenal glands glucocorticoid

ISOLATED HYPOALDOSTERONISM Associated with_____ deficiency

21-hydroxylase

ISOLATED HYPOALDOSTERONISM When there is a deficiency in 21-hydroxylase, there is an increase in ______

↑ 17-hydroxyprogesterone

HYPERALDOSTERONISM Diagnostic Tests

Urinary Potassium Excretion PAC/PRA ratio Oral Salt Loading: Saline Infusion Test Captopril Suppression Test

Urinary Potassium Excretion Sample

24-hour urine

Urinary Potassium Excretion ________: suggestive of hyperaldosteronism

>30 mEq/day:

Urinary Potassium Excretion _____ renal K+ retention

<30 mEq/day:

Urinary Potassium Excretion (<30 mEq/day:) T/F: You are NOT excreting potassium at this level

F; It does not mean na hindi ka nagtatapon ng potassium

Urinary Potassium Excretion Two cases why there is a decrease in urininary K+ excretion

If the patient is using diuretics Gastrointestinal loss

Urinary Potassium Excretion If the patient is using diuretics, (inc/dec) Na+ _____ (inc/dec) K+ _____

↑ Na+ excretion ↑ K+ reabsorption

Meaning of PAC

plasma aldosterone concentration

Meaning of PRA

plasma renin activity

Most reliable method for screening primary aldosteronism

PAC/PRA ratio

PAC/PRA ratio (Patient considerations) Patient must remain ______, ___ hours prior to blood collection During blood collection, the patient should be ______ for __ to ___ minutes

ambulatory. 2 sitting down, 5-15 minutes

PAC/PRA ratio _____ – suggestive of Primary hyperaldosteronism

>30

PAC/PRA ratio _____ – diagnostic of Primary hyperaldosteronism

>50

Oral Salt Loading _____ NaCl per day for ____

5000 mg 3 days

Oral Salt Loading After 3 days, ___ is collected

24-hour urine

Oral Salt Loading What are measured:

Urine sodium; and aldosterone

Oral Salt Loading If urine sodium is ____ and aldosterone is ____, it is suggestive of primary hyperaldosteronism

200 mEq/day >12 μg/day primary hyperaldosteronism

Saline Infusion Test IV infusion of ___ NaCl for ____

2L 2 hours

Saline Infusion Test What is measured in Saline Infusion Test after IV infusion

aldosterone in the plasma

Saline Infusion Test Normal

<5 ng/dL PAC

Saline Infusion Test (Normal) (inc/dec) sodium = (inc/dec) aldosterone

↑ sodium = ↓ aldosterone

Saline Infusion Test Primary hyperaldosteronism: ____

>10 ng/dL PAC

aldosterone antagonist

Captopril

Captopril Suppression Test Normal:

Normal: ↓ aldosterone

Captopril Suppression Test Primary hyperaldosteronism:

Inc. aldosterone

Captopril Suppression Test Primary hyperaldosteronism: there will be an increase in aldosterone Specifically, if the PH is _______

aldosterone-producing adenoma (APA)

Stress hormone

CORTISOL

Principal glucocorticoid

CORTISOL

The only adrenal hormone that inhibits ACTH secretion

CORTISOL

CORTISOL The only adrenal hormone that inhibits ____

ACTH secretion

↑ cortisol = (inc/dec) ACTH

dec

Hyperglycemic hormone

CORTISOL

CORTISOL increases glucose by stimulating _______and ____

gluconeogenesis lipolysis

Anti-inflammatory and immunosuppressive actions

CORTISOL

It can inhibit/decrease antibody production

CORTISOL

CORTISOL Can be used as a therapeutic agent for ______

RA SLE; and MS

The body’s natural alarm clock

CORTISOL

Cortisol is stimulated/regulated by _______

ACTH/pituitary gland

ACTH in the circulation is bound to ____ and _______

glycoproteins transportin

Cortisol can stimulate the body/cells to produce/increase ______

energy metabolism

Cortisol is (inc/dec) during the later stage of ____

Inc sleep cycle

T/F: Pag tumataas ang cortisol, nagigising ka kasi nag increase din ang energy metabolism of the cells

True

Cortisol increases at _____ (normal sleep cycle)

8am to 10am

CORTISOL LABORATORY ANALYSIS Cortisol exhibits ___

Diurnal Rhythm

CORTISOL LABORATORY ANALYSIS (DIURNAL RHYTHM) High levels

8am - 10am

CORTISOL LABORATORY ANALYSIS (DIURNAL RHYTHM) RV

5 – 25 μg/dL

CORTISOL LABORATORY ANALYSIS (DIURNAL RHYTHM) Low levels

10pm - 12 mn

CORTISOL LABORATORY ANALYSIS Specimen

Blood urine

CORTISOL LABORATORY ANALYSIS (SPECIMEN) Since the reference value is derived at 8am, collection of _______ must be at 8am

BLOOD

CORTISOL LABORATORY ANALYSIS (SPECIMEN) Tube used in Blood collection

red top tube

CORTISOL LABORATORY ANALYSIS (SPECIMEN) What type of urine

24-hr urine

CORTISOL LABORATORY ANALYSIS Sensitive indicators of adrenal hyperfunction

Urine Free Cortisol:

Urine Free Cortisol: Sensitive indicators of ____

adrenal hyperfunction

CORTISOL LABORATORY ANALYSIS Urinary Metabolites

17-hydroxycorticosteroids 17-ketogenic steroid

CORTISOL LABORATORY ANALYSIS (URINARY METABOLITES) Measured using the Porter-Silver method

17-hydroxycorticosteroids

CORTISOL LABORATORY ANALYSIS (URINARY METABOLITES) 17-hydroxycorticosteroids is measured using ______ method

Porter-Silver method

CORTISOL LABORATORY ANALYSIS (URINARY METABOLITES) 17-hydroxycorticosteroids: Reagent used

phenylhydrazine in sulfuric acid with alcohol

CORTISOL LABORATORY ANALYSIS (URINARY METABOLITES) 17-hydroxycorticosteroids End color

Yellow

CORTISOL LABORATORY ANALYSIS (URINARY METABOLITES) Measured using Zimmerman reaction

17-ketogenic steroid

CORTISOL LABORATORY ANALYSIS (URINARY METABOLITES) 17-ketogenic steroid is measured using _______

Zimmerman reaction

CORTISOL LABORATORY ANALYSIS (URINARY METABOLITES) 17-ketogenic steroid Reagent::

metadinitrobenzen

CORTISOL LABORATORY ANALYSIS (URINARY METABOLITES) 17-ketogenic steroid End color

reddish purple

Glucocorticoids are degraded in the ___ and excreted in the ___+ in the form of ___

liver urine metabolites

Conditions associated with Cortisol

Hypercortisolism Hypocortisolism

Example of Hypercortisolism

Cushing’s Syndrome

HYPERCORTISOLISM Excessive glucocorticoid production due to excessive production of cortisol or ACTH

Cushing’s Syndrome

HYPERCORTISOLISM (CUSHING SYNDROME) Excessive ____ production due to excessive production of ___ or ___

glucocorticoid cortisol ACTH

HYPERCORTISOLISM ↑ ACTH = ___

Cushing’s disease

HYPERCORTISOLISM ↑ cortisol, normal ACTH = ___

Cushing’s syndrome

HYPERCORTISOLISM Major common cause of Cushing's Disease ________________ Excess ____ or ___ production

ACTH-secreting pituitary adenoma ACTH, CRH

HYPERCORTISOLISM Major common cause of Cushing's Syndrome

Adrenal tumor

causing autonomous cortisol production

Adrenal tumor

CUSHING'S SYNDROME Features:

Obesity with thin extremities

CUSHING'S SYNDROME Other features

Buffalo hump hirsutism pendulum abdomen moon face appearance easily bruised

CUSHING'S DX (secondary/primary) hypercortisolism

Secondary

CUSHING'S SYNDROME (secondary/primary) hypercortisolism

Primary

CUSHING'S DX Gland affected

Pituitary gland

CUSHING'S SYNDROME Gland affected

adrenal cortex

CUSHING'S Which is more serious

CUSHING'S DX

CUSHING'S Which is less serious

CUSHING'S SYNDROME

CUSHING'S Which is less common

CUSHING'S DX

CUSHING'S Which is more common

CUSHING'S SYNDROME

CUSHING'S DX CAUSE:

Pituitary tumor that secretes ACTH

CUSHING'S DX INC:

ACTH CORTISOL

CUSHING'S SYNDROME Increaaseed

Cortisol

CUSHING'S SYNDROME Decreased in:

NORMAL ACTH

Develops due to abnormal tumor growth

CUSHING'S DX

Associated with hyperpigmentation

CUSHING'S DX

Develops most often from taking medications that increase cortisol

CUSHING'S SYNDROME

CUSHING'S SYNDROME LABORATORY ANALYSIS Screening tests

24-hour urine free cortisol Overnight Dexamethasone Suppression Test Midnight Salivary Cortisol Test

CUSHING'S SYNDROME LABORATORY ANALYSIS (Screening Tests) Requires accurate collection and urine volume measurement

24-hour urine free cortisol

CUSHING'S SYNDROME LABORATORY ANALYSIS (Screening Tests) Affected by increased fluid intake (_) and urine volume of _

>5L >3L

CUSHING'S SYNDROME LABORATORY ANALYSIS (Screening Tests) An increased fluid intake (>5L) and urine volume of >3L can caused false (posi/nega)

false positive

CUSHING'S SYNDROME LABORATORY ANALYSIS (Screening Tests) Cortisol value of ___ above normal is suggestive of ______

24-hour urine free cortisol 3x cortisol excess

CUSHING'S SYNDROME LABORATORY ANALYSIS (Screening Tests) Administer 1 mg dexamethasone between 11pm and 12am

Overnight Dexamethasone Suppression Test

CUSHING'S SYNDROME LABORATORY ANALYSIS (Screening Tests) Overnight Dexamethasone Suppression Test Administer ____ between ____ and ____

1 mg dexamethasone 11pm and 12 am

CUSHING'S SYNDROME LABORATORY ANALYSIS (Screening Tests) Overnight Dexamethasone Suppression Test Blood is then collected at __ ___ is measured

8am cortisol

CUSHING'S SYNDROME LABORATORY ANALYSIS (Screening Tests) Overnight Dexamethasone Suppression Test Normally, cortisol after dexamethasone administration should be ___

>1.8 μg/dL

CUSHING'S SYNDROME LABORATORY ANALYSIS (Screening Tests) Also known as late night salivary cortisol test

Midnight Salivary Cortisol Test

CUSHING'S SYNDROME LABORATORY ANALYSIS (Screening Tests) Midnight Salivary Cortisol Test a.k.a

late night salivary cortisol test

CUSHING'S SYNDROME LABORATORY ANALYSIS (Screening Tests) The patient should avoid smoking prior to collection

Midnight Salivary Cortisol Test

CUSHING'S SYNDROME LABORATORY ANALYSIS CONFIRMATORY TESTS

Low-dose Dexamethasone Suppression Test Midnight Plasma Cortisol Corticotropin-releasing Hormone Stimulation test

CUSHING'S SYNDROME LABORATORY ANALYSIS (CONFIRMATORY TESTS) 0.5 mg of dexamethasone is administered every 6 hours for 2 days

Low-dose Dexamethasone Suppression Test

CUSHING'S SYNDROME LABORATORY ANALYSIS (CONFIRMATORY TESTS) Low-dose Dexamethasone Suppression Test ___ of dexamethasone is administered every ___for ___

0.5 mg 6 hours 2 days

CUSHING'S SYNDROME LABORATORY ANALYSIS (CONFIRMATORY TESTS) Low-dose Dexamethasone Suppression Test 0.5 mg of dexamethasone is administered ___(total for 2 days)

8 times

CUSHING'S SYNDROME LABORATORY ANALYSIS (CONFIRMATORY TESTS) Low-dose Dexamethasone Suppression Test For every administration, blood is collected after ____ __ times din ang collection of blood

15 minutes 8

CUSHING'S SYNDROME LABORATORY ANALYSIS (CONFIRMATORY TESTS) Low-dose Dexamethasone Suppression Test Normally, there should be (inc/dec) cortisol

Decreased

CUSHING'S SYNDROME LABORATORY ANALYSIS (CONFIRMATORY TESTS) Low-dose Dexamethasone Suppression Test Patients with ________ show an (inc/dec) cortisol

hypercortisolism inc

CUSHING'S SYNDROME LABORATORY ANALYSIS (CONFIRMATORY TESTS) Special Requirement: The patient should be admitted to the hospital before ___ because the patient should be ____ during blood collection

Midnight Plasma Cortisol 10pm asleep

CUSHING'S SYNDROME LABORATORY ANALYSIS (CONFIRMATORY TESTS) It will identify if the in cholesterol is ACTH dependent or ACTH-independent

Corticotropin-releasing Hormone Stimulation test

CUSHING'S SYNDROME LABORATORY ANALYSIS (CONFIRMATORY TESTS) Corticotropin-releasing Hormone Stimulation test It will identify if the increase in cholesterol is ________ or _________

ACTH dependent ACTH-independent

CUSHING'S SYNDROME LABORATORY ANALYSIS (CONFIRMATORY TESTS) Corticotropin-releasing Hormone Stimulation test ___ and ___ are measured after the administration of __

Cortisol ACTH CRH

CUSHING'S SYNDROME LABORATORY ANALYSIS (CONFIRMATORY TESTS) Corticotropin-releasing Hormone Stimulation test ACTH-dependent: (dec/inc) ACTH, cortisol

inc

CUSHING'S SYNDROME LABORATORY ANALYSIS (CONFIRMATORY TESTS) Corticotropin-releasing Hormone Stimulation test ACTH-independent: (inc/dec) ACTH, (inc/dec) cortisol

↓ ACTH, ↑ cortisol

What condition is associated with Hypocortisolism?

Addison’s Disease

Primary adrenal insufficiency

Addison’s Disease

Hypocortisolism will only occur if_____ of the adrenal gland is destroyed

90% Addison’s Disease

What is associated with Addison's Disease

Hypocortisolism; and hypoaldosteronism

HYPORCORTISOLISM - ADDISON'S DX Primary Adrenal Problem

o Autoimmune adrenalitis o Fungal disease o HIV Infection o Tuberculosis o Bilateral Adrenal Hemorrhage o Adrenoleukodystrophy o Infiltrative processes o Metastasis

antibody against adrenal gland

Autoimmune adrenalitis

HYPORCORTISOLISM - ADDISON'S DX OTHER CAUSES

o Secondary to ACTH deficiency o Glucocorticoid therapy o Tumors o Developmental abnormalities o Malignancies

HYPORCORTISOLISM - ADDISON'S DX Secondary adrenal insufficiency

Secondary to ACTH deficiency

HYPORCORTISOLISM - ADDISON'S DX Most common cause

Glucocorticoid therapy

HYPORCORTISOLISM - ADDISON'S DX Causes hypocortisolism

Glucocorticoid therapy

HYPORCORTISOLISM - ADDISON'S DX HYPOCORTISOLISM (↑ cortisol = (inc/dec) CRH = (inc/dec) ACTH = (inc/dec) cortisol)

↑ cortisol = ↓ CRH = ↓ ACTH = ↓ cortisol

[M6] Part 3: Adrenal Gland Flashcards

(270 cards)