Pathology of the Adrenal I

Question 1

glucocorticoid production

Answer 1

zona fasciculata

cortisol

Question 2

mineralocorticoid production

Answer 2

zona glomerulosa

aldosterone

Question 3

sex steroid production

Answer 3

zona reticularis

estrogens and androgens

Question 4

chromaffin cells

Answer 4

in adrenal medulla

secrete catecholamines

epinephrine

Question 5

cushings syndrome

Answer 5

hypercortisol

Question 6

central obesity, moon facies, abdominal striae

Answer 6

cushings

Question 7

elevated glucocorticoid levels

Answer 7

cushing

exogenous and endogenous

Question 8

exogenous cushings

Answer 8

iatrogenic

admin of exogenous glucocorticoids

Question 9

endogenous cushings

Answer 9

ACTH dependent

ACTH independent

Question 10

ACTH dependent cushings

Answer 10

pituitary adenoma - producing ACTH

Question 11

ectopic ACTH

Answer 11

small cell lung cancer

but rare

Question 12

ACTH independent cushings

Answer 12

adrenal adenoma or carcinoma

elevated cortisol and low ACTH

Question 13

majority of endogenous hypercortisolism

Answer 13

ACTH secreting pituitary adenoma

Question 14

cushing disease

Answer 14

ACTH producing pituitary adenoma

more in women - young adults

Question 15

most common cause of ACTH-indepenent cushing syndome

Answer 15

primary adrenal neopalsms

adenomas and carcinomas

Question 16

crooke hyaline change

Answer 16

pituitary adenoma
-producing ACTH

cushings disease

Question 17

adrenal cortex color

Answer 17

yellow

Question 18

HTN and weight gain

Answer 18

seen early with cushings syndrome

Question 19

buffalo hump

Answer 19

cushings

Question 20

hypercortisol and muscle

Answer 20

atrophy of type 2 myofibers

decreased muscle mass and proximal limb weakness

Question 21

striae in cushings

Answer 21

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

loss of collagen and bone resorption

skin thin fragile and easily bruised - striae occurs

Question 22

lady stops menstruating

overweight, HTN, striae, increased cortisol

Answer 22

cushings

Question 23

decreased libido

Answer 23

in cushings

Question 24

lab diagnosis of cushings

Answer 24

24 hour urine free cortisol increased

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

Question 25

dexamethasone suppression test

Answer 25

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

Question 26

ectopic ACTH vs. adrenal tumor

Answer 26

ectopic - high ACTH | adrenal tumor - low ACTH

Question 27

primary hyperaldosteronism

Answer 27

excess aldosterone secretion may be primary or secondary decreased renin activity

Question 28

common symptom in primary hyperaldosteronism

Answer 28

BP elevation due to too much Na

Question 29

conns syndrome

Answer 29

primary hyperaldosteronism adrenal aldosteronoma solitary aldosterone secreting adenoma -surgery

Question 30

bilateral adrenal hyperplasia

Answer 30

primary adrenal hyperaldosteronism tx - spironolactone

Question 31

CYP11B2

Answer 31

chromosome 8 altered in glucocorticoid remediable hyperaldosteronism

Question 32

most common primary hyperaldosteronism

Answer 32

idiopathic - bilateral enlargement tx - medical - spironolactone

Question 33

secondary hyperaldosteronism

Answer 33

with increased plasma renin 1 - renal artery stenosis 2 - arterial hypovolemia and edema 3 - pregnancy

Question 34

renal artery stenosis

Answer 34

decreased renal perfusion - increased renin - secondary hyperaldosteronism

Question 35

spironolactone bodies

Answer 35

in aldosterone producing adenoma

Question 36

hyperaldosteronism clinical

Answer 36

hypertension long term - left ventricular hypertrophy and reduced diastolic volume strokes and MI

Question 37

diagnosis of primary hyperaldosteronism

Answer 37

elevated ratio of plasma aldosterone to plasma renin confirmatory aldosterone suppression test must be performed**

Question 38

virilization

Answer 38

development of sex differences in male and female

Question 39

adrenal causes of androgen excess

Answer 39

adrenocortical neoplasms congenital adrenal hyperplasia

Question 40

two compounds from adrenal cortex that can be converted to testosterone

Answer 40

dehydroepiandrosterone androstenedione

Question 41

21 hydroxylase deficiency

Answer 41

too much testosterone formation female gets hairy

Question 42

congenital adrenal hyperplasia

Answer 42

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

Question 43

mutation in CYP21A2

Answer 43

21 hydroxylase deficiency main cause of congenital adrenal hyperplasia** 3 adrenogenitalism syndromes: 1 - salt wasting - classic 2 - virilizing 3 - nonclassic

Question 44

salt wasting syndrome

Answer 44

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**

Question 45

higher K/Na ratio

Answer 45

severe tetany

Question 46

simple virilizing adrenogenital syndrome

Answer 46

genital ambiguity 1/3 pt with 21-hydroxylase deficiency enough mineralocorticoids to prevent salt wasting crisis increased testosterone - progressive virilization

Question 47

salt wasting crisis at birth**

Answer 47

21 hydroxylase deficiency - congeintal adrenal hyperplasia - salt wasting syndrome produce no mineralocorticoids

Question 48

late onset adrenal virilism

Answer 48

nonclassic congenital adrenal hyperplasia partial 21 hydroxylase deficiency

Question 49

hirsutism, acne, menstrual irregularity

Answer 49

nonclassic - adrenal virilism partial deficiency of 21 hydroxylase

Question 50

all cases of congenital adrenal hyperplasia

Answer 50

adrenals are bilaterally hyperplastic

Question 51

congeintal adrenal hyerplasia in males

Answer 51

21 hydroxylase deficiency -excessive androgens enlarged external genitalia and other evidence of precocious puberty older males - oligospermia

Question 52

ambiguous genitalia

Answer 52

suspect congneital adrenal hyperplasia