Pathology of the Adrenal I Flashcards Preview

Endo II > Pathology of the Adrenal I > Flashcards

Flashcards in Pathology of the Adrenal I Deck (52):
1

glucocorticoid production

zona fasciculata

cortisol

2

mineralocorticoid production

zona glomerulosa

aldosterone

3

sex steroid production

zona reticularis

estrogens and androgens

4

chromaffin cells

in adrenal medulla

secrete catecholamines

epinephrine

5

cushings syndrome

hypercortisol

6

central obesity, moon facies, abdominal striae

cushings

7

elevated glucocorticoid levels

cushing

exogenous and endogenous

8

exogenous cushings

iatrogenic

admin of exogenous glucocorticoids

9

endogenous cushings

ACTH dependent

ACTH independent

10

ACTH dependent cushings

pituitary adenoma - producing ACTH

11

ectopic ACTH

small cell lung cancer

but rare

12

ACTH independent cushings

adrenal adenoma or carcinoma

elevated cortisol and low ACTH

13

majority of endogenous hypercortisolism

ACTH secreting pituitary adenoma

14

cushing disease

ACTH producing pituitary adenoma

more in women - young adults

15

most common cause of ACTH-indepenent cushing syndome

primary adrenal neopalsms

adenomas and carcinomas

16

crooke hyaline change

pituitary adenoma
-producing ACTH

cushings disease

17

adrenal cortex color

yellow

18

HTN and weight gain

seen early with cushings syndrome

19

buffalo hump

cushings

20

hypercortisol and muscle

atrophy of type 2 myofibers

decreased muscle mass and proximal limb weakness

21

striae in cushings

glucocorticoids induce gluconeogenesis - hyperglycemia, glucosuria, polydipsia - secondary diabetes

loss of collagen and bone resorption

skin thin fragile and easily bruised - striae occurs

22

lady stops menstruating

overweight, HTN, striae, increased cortisol

cushings

23

decreased libido

in cushings

24

lab diagnosis of cushings

24 hour urine free cortisol increased

loss of normal diurnal (high morning/low afternoon) pattern of cortisol release

25

dexamethasone suppression test

dexamethasone - suppresses ACTH secretion

in pituitary adenoma - low dose will not work, but high dose will

in ectopic ACTH or adrenal tumor low and high dose will not work

ectopic - high ACTH
adrenal tumor - low ACTH

26

ectopic ACTH vs. adrenal tumor

ectopic - high ACTH
adrenal tumor - low ACTH

27

primary hyperaldosteronism

excess aldosterone secretion

may be primary or secondary

decreased renin activity

28

common symptom in primary hyperaldosteronism

BP elevation

due to too much Na

29

conns syndrome

primary hyperaldosteronism

adrenal aldosteronoma

solitary aldosterone secreting adenoma

-surgery

30

bilateral adrenal hyperplasia

primary adrenal hyperaldosteronism

tx - spironolactone

31

CYP11B2

chromosome 8

altered in glucocorticoid remediable hyperaldosteronism

32

most common primary hyperaldosteronism

idiopathic - bilateral enlargement

tx - medical - spironolactone

33

secondary hyperaldosteronism

with increased plasma renin

1 - renal artery stenosis
2 - arterial hypovolemia and edema
3 - pregnancy

34

renal artery stenosis

decreased renal perfusion
-increased renin
-secondary hyperaldosteronism

35

spironolactone bodies

in aldosterone producing adenoma

36

hyperaldosteronism clinical

hypertension

long term - left ventricular hypertrophy and reduced diastolic volume

strokes and MI

37

diagnosis of primary hyperaldosteronism

elevated ratio of plasma aldosterone to plasma renin

confirmatory aldosterone suppression test must be performed**

38

virilization

development of sex differences in male and female

39

adrenal causes of androgen excess

adrenocortical neoplasms

congenital adrenal hyperplasia

40

two compounds from adrenal cortex that can be converted to testosterone

dehydroepiandrosterone

androstenedione

41

21 hydroxylase deficiency

too much testosterone formation

female gets hairy

42

congenital adrenal hyperplasia

auto recessive

deficiency or total lack of enzymes involved in biosynthesis of cortical steroids

43

mutation in CYP21A2

21 hydroxylase deficiency

main cause of congenital adrenal hyperplasia**

3 adrenogenitalism syndromes:
1 - salt wasting - classic
2 - virilizing
3 - nonclassic

44

salt wasting syndrome

congenital adrenal hyperplasia
-total lack of 21 hydroxylase

no synthesis of mineralocorticoids

also deficient cortisol

excess androgens - virilization occurs

male - unrecognized

a birth - see a salt wasting crisis**

45

higher K/Na ratio

severe tetany

46

simple virilizing adrenogenital syndrome

genital ambiguity

1/3 pt with 21-hydroxylase deficiency

enough mineralocorticoids to prevent salt wasting crisis

increased testosterone - progressive virilization

47

salt wasting crisis at birth**

21 hydroxylase deficiency
-congeintal adrenal hyperplasia
-salt wasting syndrome

produce no mineralocorticoids

48

late onset adrenal virilism

nonclassic congenital adrenal hyperplasia

partial 21 hydroxylase deficiency

49

hirsutism, acne, menstrual irregularity

nonclassic - adrenal virilism

partial deficiency of 21 hydroxylase

50

all cases of congenital adrenal hyperplasia

adrenals are bilaterally hyperplastic

51

congeintal adrenal hyerplasia in males

21 hydroxylase deficiency
-excessive androgens

enlarged external genitalia and other evidence of precocious puberty

older males - oligospermia

52

ambiguous genitalia

suspect congneital adrenal hyperplasia