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[LECT] CC 2 - Finals > [M6] Part 3: Adrenal Gland > Flashcards

[M6] Part 3: Adrenal Gland Flashcards

1
Q

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

A

ADRENAL GLAND

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2
Q

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

A

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

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3
Q

Composed of 2 conjoined glands:

A

ADRENAL GLAND

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4
Q

WHAT ARE THE 2 CONJOINED GLANDS OF ADRENAL GLAND

A

Adrenal cortex
Adrenal medulla

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5
Q

Outer part of the adrenal gland.

A

ADRENAL CORTEX

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6
Q

90% of total adrenal gland

A

ADRENAL CORTEX

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7
Q

ADRENAL CORTEX is ___ of total adrenal gland

A

90%

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8
Q

ADRENAL CORTEX In cross section: ____

A

yellowish in color

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9
Q

Major site of steroid hormone production

A

ADRENAL CORTEX

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10
Q

ADRENAL CORTEX is the Major site of ___

A

steroid hormone production

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11
Q

ADRENAL CORTEX is Derived from __

A

mesenchymal cells

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12
Q

Derived from mesenchymal cells

A

ADRENAL CORTEX

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13
Q

Composed of 3 zones with distinct tissues.

A

ADRENAL CORTEX

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14
Q

3 ZONES OF ADRENAL CORTEX

A

G-ZONE
F-ZONE
R-ZONE

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14
Q

Outer part zone of Adrenal cortex

A

G-ZONE

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15
Q

10% of the total adrenal cortex

A

G-ZONE

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16
Q

G-ZONE is AKA

A

zona glomerulosa

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17
Q

G-ZONE
Hormone produced: __

A

aldosterone

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18
Q

aldosterone is a ___

A

mineralocorticoid

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19
Q

regulates sodium which is an electrolyte

A

aldosterone

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20
Q

75% of the total adrenal cortex

A

F-ZONE

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21
Q

F-ZONE is AKA

A

zona fasciculata

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22
Q

AKA zona fasciculata

A

F-ZONE

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23
Q

F-ZONE
Hormone produced: ____

A

glucocorticoids

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24
Q

F-ZONE produces glucocorticoids hormones such as ___ and ____

A

cortisol and cortisone

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25
Q

Example of glucocorticoids

A

cortisol and cortisone

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26
Q

stored form of cortisol

A

cortisone

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27
Q

F-ZONE Also produces ____

A

adrenal androgens

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28
Q

Example of adrenal androgens produced by the F-ZONE

A

dehydroepiandrosterone (DHEA)

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29
Q

DHEA stands for

A

dehydroepiandrosterone (DHEA)

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30
Q

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

A

dehydroepiandrosterone (DHEA)

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31
Q

15% of the total adrenal cortex

A

R-ZONE

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32
Q

R-ZONE is aka

A

zona reticularis

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33
Q

AKA zona reticularis

A

R-ZONE

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34
Q

R-ZONE FUNCTION

A

It sulfates DHEA

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35
Q

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

A

sulfate ;
DHEA ;
sulfated DHEA ;
DHEAS

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36
Q

Purpose of DHEAS

A

serves as the major precursor for active androgens and estrogen

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37
Q

serves as the major precursor for active androgens and estrogen

A

DHEAS

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38
Q

main adrenal androgen

A

DHEAS

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39
Q

CRH stands for

A

corticotropin-releasing hormone

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39
Q

Main regulator of Adrenal cortex

A

(CRH)

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40
Q

the production is in response to three factors

A

corticotropin-releasing hormone (CRH)

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41
Q

3 factors involved in the production of CRH

A

Low cortisol level
Stress
Circadian Rhythm

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42
Q

CRH:

Circadian Rhythm
What is the peak conc.

A

6am-8am

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43
Q

CRH:

Circadian Rhythm
What is the Lowest conc.

A

10pm-12mn

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44
Q

REGULATION:

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

hypothalamus;
pituitary gland
ACTH.

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45
Q

REGULATION:

  1. ACTH will stimulate the ____ to produce ___.
A

adrenal cortex;
Steroid hormones

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46
Q

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

A

T

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47
Q

all hormones produced by the adrenal cortex is ___

A

steroid

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48
Q

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

A

precursor

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49
Q

main precursor for steroid hormones

A

Cholesterol

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50
Q

REGULATION:

  1. ACTH will stimulate the ___ of ____ inside the ____ of adrenal cortex
A

transport ;
cholesterol ;
mitochondria

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51
Q

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

A

steroidogenesis

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52
Q

process that involves the production of steroid hormone

A

steroidogenesis

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53
Q

REGULATION:

  1. First product produced: ____
A

pregnenolone

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54
Q

serves as a substrate for all adrenal cortex hormones

A

pregnenolone

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55
Q

REGULATION:

  1. The production of the adrenal cortex hormone is influenced by the ____
A

negative feedback system.

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56
Q

↓cortisol = ___CRH

A

increased
↑CRH

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57
Q

REGULATION:

  1. However, ____ (inc/dec) cholesterol do not stimulate the ___ (produces aldosterone)
A

↓cholesterol;
G-ZONE

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58
Q

REGULATION:

  1. Remember that aldosterone is _____ by ____level bec. aldosterone production is only stimulated by the ____
A

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

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59
Q

RAAS = activates when there is a ____

A

↓BV, ↓BP

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60
Q

RAAS = activates when there is a ____

A

↓BV, ↓BP

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61
Q

↓cortisol = ____ CRH and ACTH

A

increases

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62
Q

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

A

T

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63
Q

G-ZONE will only produce aldosterone in response to ____

A

↓BV, ↓BP

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64
Q

Kidney produces ___

A

renin

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65
Q

(stimulates the production of aldosterone by the G-ZONE

A

renin

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66
Q

adrenal cortex hormone synthesis

A

Steroidogenesis

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67
Q

Before adrenal cortex hormones are produced, kailangan ng ___.

A

cholesterol

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68
Q

promotes entry of cholesterol to the mitochondria of adrenal cortex

A

ACTH

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69
Q

STEROIDOGENESIS:

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

pregnenolone ;
cytochrome p450

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70
Q

Conversion of cholesterol to pregnenolone occurs in ___

A

mitochondria

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71
Q

STEROIDOGENESIS:

  1. Once the pregnenolone is produced in the mitochondria, it will be released in the ___/___.
A

cytosol ;
cytoplasm

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72
Q

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

A

Cytoplasm

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73
Q

STEROIDOGENESIS:

  1. In the ____, pregnenolone in the cytosol may migrate to the ____/___
A

G-ZONE

F-ZONE ;
R-ZONE

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74
Q

STEROIDOGENESIS:

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

aldosterone ;
RAAS

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75
Q

STEROIDOGENESIS:

  1. Pregnenolone will be converted to ____ in the presence of__________
A

17α-OH pregnenolone ;
17-OH ase enzymes

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76
Q

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

A

17α-OH ase

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77
Q

STEROIDOGENESIS:

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

A

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

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78
Q

Cortisol is produced in response to ___ and ___

A

CRH
ACTH

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79
Q

STEROIDOGENESIS:

  1. The ____ in the ___ may migrate to the ___ to form ___ in the presence of the same enzyme (____).
A

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

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80
Q

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

A

CONGENITAL ADRENAL HYPERPLASIA (CAH)

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81
Q

Inherited family of enzyme disorders

A

CONGENITAL ADRENAL HYPERPLASIA (CAH)

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82
Q

enzyme required for steroidogenesis.

A

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

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83
Q

CONGENITAL ADRENAL HYPERPLASIA (CAH)

__ (inc/dec) cortisol and aldosterone production

A

Decreased

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84
Q

Clinical presentation depends on the enzyme affected

A

CONGENITAL ADRENAL HYPERPLASIA (CAH)

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85
Q

Types of CONGENITAL ADRENAL HYPERPLASIA (CAH)

A

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

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86
Q

Hypertension: No
Virilization: Slight

A

3ß-hydroxysteroid isomerase

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87
Q

High Laboratory Value for 3ß-hydroxysteroid isomerase

A

DHEA

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88
Q

Hypertension: Yes
Virilization: No

A

17α-hydroxylase

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89
Q

High Laboratory Value for 17α-hydroxylase

A

Aldosterone

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90
Q

Hypertension: Yes
Virilization: Marked

A

11ß-hydroxylase

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91
Q

High Laboratory Value for 11ß-hydroxylase

A

11-deoxycorticosterone

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92
Q

Hypertension: No
Virilization: Marked

A

21ß-hydroxylase

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93
Q

High Laboratory Value for 21ß-hydroxylase

A

17-hydroxyprogesterone

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94
Q

development of masculine physical traits among women

A

Virilization

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95
Q

Example of Virilization

A

hirsutism

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96
Q

hairy women; usually seen in px with PCOS

A

hirsutism

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97
Q

Most potent mineralocorticoid

A

ALDOSTERONE

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98
Q

electron regulating hormones

A

Mineralocorticoid:

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99
Q

Increase blood pressure through volume expansion by increasing sodium reabsorption

A

ALDOSTERONE

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100
Q

Stimulates H+and K+ excretion

A

ALDOSTERONE

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101
Q

ALDOSTERONE Stimulates ____ and ___ excretion

A

H+
K+

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102
Q

It is unique among the adrenal cortex hormones

A

ALDOSTERONE

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103
Q

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

A

CRH ;
ACTH

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104
Q

ALDOSTERONE is stimulated by the ___

A

RAAS

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105
Q

RAAS is stimulated by ___ or ___

A

decreased blood pressure;
blood volume

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106
Q

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

A

kidneys;
juxtaglomerular ;
nephrons;
renin

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107
Q

Renin will convert ___ to ____

A

angiotensinogen ;
angiotensin I

108
Q

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

A

angiotensin converting enzyme (ACE) ;
lungs

109
Q

Functions of angiotensin II:
1. Stimulate the ____ to produce ___ which will then promote ____ in the________

  1. It will also stimulate the ___ to produce ____ which will promote ____ in the ____
  2. It can also ___ (INC/DEC) ___ by causing ____
  3. It can also __ (INC/DEC) ____ in the ____
A
  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)
110
Q

ADLOSTERONE SECRETION

Stimulated by:

A

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

111
Q

ALDOSTERONE SECRETION (Stimulated)

Main stimulant

A

Low Blood Pressure

112
Q

ALDOSTERONE SECRETION (Stimulated)

Angiotensin II

A

Low Blood Pressure

113
Q

ALDOSTERONE SECRETION (Stimulated)

Only stimulates aldosterone production by stimulating the entry of cholesterol in the G-ZONE

A

ACTH

114
Q

ALDOSTERONE SECRETION (Stimulated)

It does not directly stimulate the production aldosterone

A

ACTH

115
Q

ALDOSTERONE SECRETION

Inhibited by:

A

Atrial Natriuretic Peptide
Intracellular calcium
Certain drugs:

116
Q

ALDOSTERONE SECRETION (Inhibited)

What certain drugs inhibit Aldosterone Secretion?

A

Ketoconazole
ACE inhibitors
NSAIDs
Heparin

117
Q

Meaning of NSAIDS

A

Nonsteroidal anti-inflammatory drugs

118
Q

Example of NSAIDS

A

Ibuprofen

119
Q

Also termed as primary aldosteronism in some books

A

Primary Hyperaldosteronism

120
Q

Primary Hyperaldosteronism is also termed as ______ in some books

A

primary aldosteronism

121
Q

PRIMARY HYPOALDOSTERNISM

a.k.a.

A

Conn’s disease

122
Q

PRIMARY HYPOALDOSTERNISM

Caused by:

A

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

123
Q

PRIMARY HYPOALDOSTERNISM CAUSED BY

Autonomous aldosterone production due to the presence of adenoma and hyperplasia

A

Aldosterone-secreting adrenal adenoma
Unilateral/Bilateral adrenal hyperplasia

124
Q

PRIMARY HYPOALDOSTERNISM CAUSED BY

Genetic defect, hereditary

A

Familial hyperaldosteronism

125
Q

PRIMARY HYPOALDOSTERNISM CAUSED BY

Associated with carcinoma that produces ACTH

A

Adrenocortical carcinomas

126
Q

PRIMARY HYPOALDOSTERNISM CAUSED BY

May nagpo-produce ng aldosterone aside from the adrenal cortex

A

Ectopic aldosterone production

127
Q

PRIMARY HYPOALDOSTERNISM

Increased

A

plasma aldosterone

128
Q

PRIMARY HYPOALDOSTERNISM

Decreased

A

plasma renin

129
Q

Occurs as a result of excess production of renin

A

Secondary Hyperaldosteronism

130
Q

SECONDARY HYPERALDOSTERONISM

Increased

A

aldosterone and renin

131
Q

Also known as Liddle’s syndrome

A

PSEUDOHYPERALDOSTERONISM

132
Q

PSEUDOHYPERALDOSTERONISM

a.k.a

A

Liddle’s syndrome

133
Q

PSEUDOHYPERALDOSTERONISM

There are varying levels in ____and ___

A

renin
aldosterone

134
Q

PSEUDOHYPERALDOSTERONISM

T/F: Most cases have low aldosterone

A

T

135
Q

PSEUDOHYPERALDOSTERONISM

Most cases have low aldosterone except for:

A

Bartter’s Syndrome
Gitelman’s Syndrome

136
Q

PSEUDOHYPERALDOSTERONISM

bumetanide-sensitive chloride channel mutation

A

Bartter’s Syndrome

137
Q

PSEUDOHYPERALDOSTERONISM

thiazide-sensitive transporter mutation

A

Gitelman’s Syndrome

138
Q

PSEUDOHYPERALDOSTERONISM

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

A

Increase

139
Q

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

A

drug associated

140
Q

Due to destruction of adrenal glands and deficiency of glucocorticoid

A

ISOLATED HYPOALDOSTERONISM

141
Q

ISOLATED HYPOALDOSTERONISM

Due to destruction of ____ and deficiency of _____

A

adrenal glands
glucocorticoid

142
Q

ISOLATED HYPOALDOSTERONISM

Associated with_____ deficiency

A

21-hydroxylase

143
Q

ISOLATED HYPOALDOSTERONISM

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

A

↑ 17-hydroxyprogesterone

144
Q

HYPERALDOSTERONISM

Diagnostic Tests

A

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

145
Q

Urinary Potassium Excretion

Sample

A

24-hour urine

146
Q

Urinary Potassium Excretion

________: suggestive of hyperaldosteronism

A

> 30 mEq/day:

147
Q

Urinary Potassium Excretion

_____ renal K+ retention

A

<30 mEq/day:

148
Q

Urinary Potassium Excretion (<30 mEq/day:)

T/F: You are NOT excreting potassium at this level

A

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

149
Q

Urinary Potassium Excretion

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

A

If the patient is using diuretics
Gastrointestinal loss

150
Q

Urinary Potassium Excretion

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

A

↑ Na+ excretion
↑ K+ reabsorption

151
Q

Meaning of PAC

A

plasma aldosterone concentration

152
Q

Meaning of PRA

A

plasma renin activity

153
Q

Most reliable method for screening primary aldosteronism

A

PAC/PRA ratio

154
Q

PAC/PRA ratio (Patient considerations)

Patient must remain ______, ___ hours prior to blood collection

During blood collection, the patient should be ______ for __ to ___ minutes

A

ambulatory. 2

sitting down, 5-15 minutes

155
Q

PAC/PRA ratio

_____ – suggestive of Primary hyperaldosteronism

A

> 30

156
Q

PAC/PRA ratio

_____ – diagnostic of Primary hyperaldosteronism

A

> 50

157
Q

Oral Salt Loading

_____ NaCl per day for ____

A

5000 mg
3 days

158
Q

Oral Salt Loading

After 3 days, ___ is collected

A

24-hour urine

159
Q

Oral Salt Loading

What are measured:

A

Urine sodium; and
aldosterone

160
Q

Oral Salt Loading

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

A

200 mEq/day
>12 μg/day
primary hyperaldosteronism

161
Q

Saline Infusion Test

IV infusion of ___ NaCl for ____

A

2L
2 hours

162
Q

Saline Infusion Test

What is measured in Saline Infusion Test after IV infusion

A

aldosterone in the plasma

163
Q

Saline Infusion Test

Normal

A

<5 ng/dL PAC

164
Q

Saline Infusion Test (Normal)

(inc/dec) sodium = (inc/dec) aldosterone

A

↑ sodium = ↓ aldosterone

165
Q

Saline Infusion Test

Primary hyperaldosteronism: ____

A

> 10 ng/dL PAC

166
Q

aldosterone antagonist

A

Captopril

167
Q

Captopril Suppression Test

Normal:

A

Normal: ↓ aldosterone

168
Q

Captopril Suppression Test

Primary hyperaldosteronism:

A

Inc. aldosterone

169
Q

Captopril Suppression Test

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

A

aldosterone-producing adenoma (APA)

170
Q

Stress hormone

A

CORTISOL

171
Q

Principal glucocorticoid

A

CORTISOL

172
Q

The only adrenal hormone that inhibits ACTH secretion

A

CORTISOL

173
Q

CORTISOL

The only adrenal hormone that inhibits ____

A

ACTH secretion

174
Q

↑ cortisol = (inc/dec) ACTH

A

dec

175
Q

Hyperglycemic hormone

A

CORTISOL

176
Q

CORTISOL

increases glucose by stimulating _______and ____

A

gluconeogenesis
lipolysis

177
Q

Anti-inflammatory and immunosuppressive actions

A

CORTISOL

178
Q

It can inhibit/decrease antibody production

A

CORTISOL

179
Q

CORTISOL

Can be used as a therapeutic agent for ______

A

RA
SLE; and
MS

180
Q

The body’s natural alarm clock

A

CORTISOL

181
Q

Cortisol is stimulated/regulated by _______

A

ACTH/pituitary gland

182
Q

ACTH in the circulation is bound to ____ and _______

A

glycoproteins
transportin

183
Q

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

A

energy metabolism

184
Q

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

A

Inc
sleep cycle

185
Q

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

A

True

186
Q

Cortisol increases at _____ (normal sleep cycle)

A

8am to 10am

187
Q

CORTISOL LABORATORY ANALYSIS

Cortisol exhibits ___

A

Diurnal Rhythm

188
Q

CORTISOL LABORATORY ANALYSIS (DIURNAL RHYTHM)

High levels

A

8am - 10am

189
Q

CORTISOL LABORATORY ANALYSIS (DIURNAL RHYTHM)

RV

A

5 – 25 μg/dL

190
Q

CORTISOL LABORATORY ANALYSIS (DIURNAL RHYTHM)

Low levels

A

10pm - 12 mn

191
Q

CORTISOL LABORATORY ANALYSIS

Specimen

A

Blood
urine

192
Q

CORTISOL LABORATORY ANALYSIS (SPECIMEN)

Since the reference value is derived at 8am, collection of _______ must be at 8am

A

BLOOD

193
Q

CORTISOL LABORATORY ANALYSIS (SPECIMEN)

Tube used in Blood collection

A

red top tube

194
Q

CORTISOL LABORATORY ANALYSIS (SPECIMEN)

What type of urine

A

24-hr urine

195
Q

CORTISOL LABORATORY ANALYSIS

Sensitive indicators of adrenal hyperfunction

A

Urine Free Cortisol:

196
Q

Urine Free Cortisol: Sensitive indicators of ____

A

adrenal hyperfunction

197
Q

CORTISOL LABORATORY ANALYSIS

Urinary Metabolites

A

17-hydroxycorticosteroids
17-ketogenic steroid

198
Q

CORTISOL LABORATORY ANALYSIS (URINARY METABOLITES)

Measured using the Porter-Silver method

A

17-hydroxycorticosteroids

199
Q

CORTISOL LABORATORY ANALYSIS (URINARY METABOLITES)

17-hydroxycorticosteroids is measured using ______ method

A

Porter-Silver method

200
Q

CORTISOL LABORATORY ANALYSIS (URINARY METABOLITES)

17-hydroxycorticosteroids: Reagent used

A

phenylhydrazine in sulfuric acid with alcohol

201
Q

CORTISOL LABORATORY ANALYSIS (URINARY METABOLITES)

17-hydroxycorticosteroids

End color

A

Yellow

202
Q

CORTISOL LABORATORY ANALYSIS (URINARY METABOLITES)

Measured using Zimmerman reaction

A

17-ketogenic steroid

203
Q

CORTISOL LABORATORY ANALYSIS (URINARY METABOLITES)

17-ketogenic steroid is measured using _______

A

Zimmerman reaction

204
Q

CORTISOL LABORATORY ANALYSIS (URINARY METABOLITES)

17-ketogenic steroid

Reagent::

A

metadinitrobenzen

205
Q

CORTISOL LABORATORY ANALYSIS (URINARY METABOLITES)

17-ketogenic steroid

End color

A

reddish purple

206
Q

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

A

liver
urine
metabolites

207
Q

Conditions associated with Cortisol

A

Hypercortisolism
Hypocortisolism

208
Q

Example of Hypercortisolism

A

Cushing’s Syndrome

209
Q

HYPERCORTISOLISM

Excessive glucocorticoid production due to excessive production of cortisol or ACTH

A

Cushing’s Syndrome

210
Q

HYPERCORTISOLISM (CUSHING SYNDROME)

Excessive ____ production due to excessive production of ___ or ___

A

glucocorticoid
cortisol
ACTH

211
Q

HYPERCORTISOLISM

↑ ACTH = ___

A

Cushing’s disease

212
Q

HYPERCORTISOLISM

↑ cortisol, normal ACTH = ___

A

Cushing’s syndrome

213
Q

HYPERCORTISOLISM

Major common cause of Cushing’s Disease

________________
Excess ____ or ___ production

A

ACTH-secreting pituitary adenoma
ACTH, CRH

214
Q

HYPERCORTISOLISM

Major common cause of Cushing’s Syndrome

A

Adrenal tumor

215
Q

causing autonomous cortisol production

A

Adrenal tumor

216
Q

CUSHING’S SYNDROME

Features:

A

Obesity with thin extremities

217
Q

CUSHING’S SYNDROME

Other features

A

Buffalo hump
hirsutism
pendulum abdomen
moon face appearance
easily bruised

218
Q

CUSHING’S DX

(secondary/primary) hypercortisolism

A

Secondary

219
Q

CUSHING’S SYNDROME

(secondary/primary) hypercortisolism

A

Primary

220
Q

CUSHING’S DX

Gland affected

A

Pituitary gland

221
Q

CUSHING’S SYNDROME

Gland affected

A

adrenal cortex

222
Q

CUSHING’S

Which is more serious

A

CUSHING’S DX

223
Q

CUSHING’S

Which is less serious

A

CUSHING’S SYNDROME

224
Q

CUSHING’S

Which is less common

A

CUSHING’S DX

225
Q

CUSHING’S

Which is more common

A

CUSHING’S SYNDROME

226
Q

CUSHING’S DX

CAUSE:

A

Pituitary tumor that secretes ACTH

227
Q

CUSHING’S DX

INC:

A

ACTH
CORTISOL

228
Q

CUSHING’S SYNDROME

Increaaseed

A

Cortisol

229
Q

CUSHING’S SYNDROME

Decreased in:

A

NORMAL ACTH

230
Q

Develops due to abnormal tumor growth

A

CUSHING’S DX

231
Q

Associated with hyperpigmentation

A

CUSHING’S DX

232
Q

Develops most often from taking medications that increase cortisol

A

CUSHING’S SYNDROME

233
Q

CUSHING’S SYNDROME LABORATORY ANALYSIS

Screening tests

A

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

234
Q

CUSHING’S SYNDROME LABORATORY ANALYSIS (Screening Tests)

Requires accurate collection and urine volume measurement

A

24-hour urine free cortisol

235
Q

CUSHING’S SYNDROME LABORATORY ANALYSIS (Screening Tests)

Affected by increased fluid intake (_) and urine volume of _

A

> 5L
3L

236
Q

CUSHING’S SYNDROME LABORATORY ANALYSIS (Screening Tests)

An increased fluid intake (>5L) and urine volume of >3L can caused false (posi/nega)

A

false positive

237
Q

CUSHING’S SYNDROME LABORATORY ANALYSIS (Screening Tests)

Cortisol value of ___ above normal is suggestive of ______

A

24-hour urine free cortisol
3x
cortisol excess

238
Q

CUSHING’S SYNDROME LABORATORY ANALYSIS (Screening Tests)

Administer 1 mg dexamethasone between 11pm and 12am

A

Overnight Dexamethasone Suppression Test

239
Q

CUSHING’S SYNDROME LABORATORY ANALYSIS (Screening Tests)

Overnight Dexamethasone Suppression Test

Administer ____ between ____ and ____

A

1 mg dexamethasone
11pm and 12 am

240
Q

CUSHING’S SYNDROME LABORATORY ANALYSIS (Screening Tests)

Overnight Dexamethasone Suppression Test

Blood is then collected at __
___ is measured

A

8am
cortisol

241
Q

CUSHING’S SYNDROME LABORATORY ANALYSIS (Screening Tests)

Overnight Dexamethasone Suppression Test

Normally, cortisol after dexamethasone administration should be ___

A

> 1.8 μg/dL

242
Q

CUSHING’S SYNDROME LABORATORY ANALYSIS (Screening Tests)

Also known as late night salivary cortisol test

A

Midnight Salivary Cortisol Test

243
Q

CUSHING’S SYNDROME LABORATORY ANALYSIS (Screening Tests)

Midnight Salivary Cortisol Test a.k.a

A

late night salivary cortisol test

244
Q

CUSHING’S SYNDROME LABORATORY ANALYSIS (Screening Tests)

The patient should avoid smoking prior to collection

A

Midnight Salivary Cortisol Test

245
Q

CUSHING’S SYNDROME LABORATORY ANALYSIS

CONFIRMATORY TESTS

A

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

246
Q

CUSHING’S SYNDROME LABORATORY ANALYSIS (CONFIRMATORY TESTS)

0.5 mg of dexamethasone is administered every 6 hours for 2 days

A

Low-dose Dexamethasone Suppression Test

247
Q

CUSHING’S SYNDROME LABORATORY ANALYSIS (CONFIRMATORY TESTS)

Low-dose Dexamethasone Suppression Test

___ of dexamethasone is administered every ___for ___

A

0.5 mg
6 hours
2 days

248
Q

CUSHING’S SYNDROME LABORATORY ANALYSIS (CONFIRMATORY TESTS)

Low-dose Dexamethasone Suppression Test

0.5 mg of dexamethasone is administered ___(total for 2 days)

A

8 times

249
Q

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

A

15 minutes
8

250
Q

CUSHING’S SYNDROME LABORATORY ANALYSIS (CONFIRMATORY TESTS)

Low-dose Dexamethasone Suppression Test

Normally, there should be (inc/dec) cortisol

A

Decreased

251
Q

CUSHING’S SYNDROME LABORATORY ANALYSIS (CONFIRMATORY TESTS)

Low-dose Dexamethasone Suppression Test

Patients with ________ show an (inc/dec) cortisol

A

hypercortisolism
inc

252
Q

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

A

Midnight Plasma Cortisol

10pm
asleep

253
Q

CUSHING’S SYNDROME LABORATORY ANALYSIS (CONFIRMATORY TESTS)

It will identify if the in cholesterol is ACTH dependent or ACTH-independent

A

Corticotropin-releasing Hormone Stimulation test

254
Q

CUSHING’S SYNDROME LABORATORY ANALYSIS (CONFIRMATORY TESTS)

Corticotropin-releasing Hormone Stimulation test

It will identify if the increase in cholesterol is ________ or _________

A

ACTH dependent
ACTH-independent

255
Q

CUSHING’S SYNDROME LABORATORY ANALYSIS (CONFIRMATORY TESTS)

Corticotropin-releasing Hormone Stimulation test

___ and ___ are measured after the administration of __

A

Cortisol
ACTH
CRH

256
Q

CUSHING’S SYNDROME LABORATORY ANALYSIS (CONFIRMATORY TESTS)

Corticotropin-releasing Hormone Stimulation test

ACTH-dependent: (dec/inc) ACTH, cortisol

A

inc

257
Q

CUSHING’S SYNDROME LABORATORY ANALYSIS (CONFIRMATORY TESTS)

Corticotropin-releasing Hormone Stimulation test

ACTH-independent: (inc/dec) ACTH, (inc/dec) cortisol

A

↓ ACTH, ↑ cortisol

258
Q

What condition is associated with Hypocortisolism?

A

Addison’s Disease

259
Q

Primary adrenal insufficiency

A

Addison’s Disease

260
Q

Hypocortisolism will only occur if_____ of the adrenal gland is destroyed

A

90%
Addison’s Disease

261
Q

What is associated with Addison’s Disease

A

Hypocortisolism; and
hypoaldosteronism

262
Q

HYPORCORTISOLISM - ADDISON’S DX

Primary Adrenal Problem

A

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

263
Q

antibody against adrenal gland

A

Autoimmune adrenalitis

264
Q

HYPORCORTISOLISM - ADDISON’S DX

OTHER CAUSES

A

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

265
Q

HYPORCORTISOLISM - ADDISON’S DX

Secondary adrenal insufficiency

A

Secondary to ACTH deficiency

266
Q

HYPORCORTISOLISM - ADDISON’S DX

Most common cause

A

Glucocorticoid therapy

267
Q

HYPORCORTISOLISM - ADDISON’S DX

Causes hypocortisolism

A

Glucocorticoid therapy

268
Q

HYPORCORTISOLISM - ADDISON’S DX

HYPOCORTISOLISM (↑ cortisol = (inc/dec) CRH = (inc/dec) ACTH = (inc/dec) cortisol)

A

↑ cortisol = ↓ CRH = ↓ ACTH = ↓ cortisol

[LECT] CC 2 - Finals (9 decks)

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