SECRETS Endo - Adrenals

Question 1

cushing syndrome sx

Answer 1

weakness
amenorrhea
deepening voice
central obesity
abdominal striae
buffalo hump
acanthosis nigricans

hyperglycemia
elevated random cortisol

Question 2

cushing syndrome causes

Answer 2

iatrogenic glucocorticoids
cortisol-hypersecreting adrenal adenoma/carcinoma
ACTH-secreting pituitary adenoma
paraneoplastic secretion (small cell lung carcinoma)

Question 3

cushing disease

Answer 3

elevated ACTH & cortisol

responsive to high dose dexamethasone

Question 4

hypercortisolism - hyperglycermia

Answer 4

cortisol promotes hyperglycemia via ++ hepatic gluconeogenesis

mobilize aa from skeletal muscle (muscle wasting)
synthesis of gluconeogenic enzymes

Question 5

hypercortisolism - hypertension

Answer 5

high plasma levels - cortisol is mineralocortic

hypernatremia, hypervolemia, hypokalemia

++ adrenergic receptors in vascular smooth muscle

Question 6

normal plasma levels of cortisol - mineralocorticoid?

Answer 6

NO

sensitive tissues have 11B-hydroxysteroid dehydrogenase = metabolize cortisol

high levels = oversaturate 11B-HSD –> bind aldosterone receptors

Question 7

licorice candy - cortisol

Answer 7

+++ cortisol

decrease activity of 11B-HSD

Question 8

cortisol - bones

Answer 8

loss of bone density, osteoporosis

inhibit osteoblast, stimulate osteoclast

promote bone resorption

Question 9

layers of adrenal cortex

Answer 9

Glomerulosa = mineralocorticoids
Fasciculata = cortisol
Reticularis = sex steroids

Medulla = NE, E

Question 10

Nelson’s syndrome

Answer 10

diffuse hyperpigmentation due to + MSH production following bilateral adrenalectomy

++ ACTH/MSH production (from POMC) in pituitary

Question 11

adrenal insufficiency sx

Answer 11

vague sx (weakness, malaise)

hyponatremia
hyperkalemia
hypoglycemia
hypotension

Question 12

Addison’s disease & causes

Answer 12

primary adrenal insufficiency

due to autoimmune destruction, TB, metastatic invasion (lung cancer), disseminated fungal infections, drugs/iatrogenic steroids (ketoconazole, metyrapone)

Question 13

cosyntropin

Answer 13

dx primary vs secondary adrenal insufficiency

blunted response = primary
normal response = secondary

Question 14

Waterhouse-Friderichsen syndrome

Answer 14

bilateral adrenal hemorrhage
fatal
neisseria meningitidis

Question 15

pheochromocytoma sx

Answer 15

headache
palpitations
profuse sweating
“impending doom”

intermittent episodes

Question 16

why does HTN worsen with BB in pheochromocytoma?

Answer 16

epinephrine stimulates a & B adrenergic receptors

in presence of BB, will bind only a –> vasoconstriction

Question 17

pheochromocytoma origin

Answer 17

neural crest derived chromaffin cells of adrenal medulla

Question 18

use of clonidine in pheochromocytoma dx

Answer 18

differentiate from high stress state

central a2 agonist = inhibit sympa outflow

should reduce catecholamine production - if not, pheochromocytoma!

Question 19

rule of 10s pheochromoctyoma

Answer 19

10% familial
10% extra adrenal
10% malignant
10% in kids
10% calcified
10% bilateral

Question 20

familial pheochromocytoma

Answer 20

MEN IIa or IIb
VHL
neurofibromatosis

Question 21

Neuroblastoma

Answer 21

neuroendocrine tumor
kids <5

hypertension
palpable abdominal mass
opsoclonus-myoclonus syndrome (chaotic eye movements)

mets to skin, bone, post mediastinum

N-myc oncogene

Homer-Wright rosettes

Question 22

tx pheochromocytoma

Answer 22

a-blocker (zosin) FIRST
then BB (olol)

surgery = give phenoxybenzamine FIRST