Week 4- Adrenal

Question 1

What is Conn syndrome

Answer 1

primary hyperaldosteronism

• hypertension
• hypokalemia
• can get polyuria and polydipsia

Question 2

What are two ways an adrenal tumour could cause hyperglycemia?

Answer 2

aldosteronism: hypokalemia can decrease insulin secretion (don’t know how)
cortisol: promotes gluconeigenesis etc…

Question 3

Does cortisol decrease or increase the rate of free water clearance?

Answer 3

Increase

Question 4

What kind of mutation does MEN1, MEN2a and MEN2b have? What are the features of each?

Answer 4

MEN1: menin gene gain of function (AD)

• parathyroid
• pancreatic islet cell tumours
• pituitary

MEN2a/2b: RET- protooncogene

• both have pheo and MCT
• 2a: parathyroid
• 2b: neuromas/ development

Question 5

Are the following side effects associated with long-term glucocorticoid use

Decreased susceptibility for infections
Hypercalcemia
Hyperkalemia
Acceleration of growth

Question 6

What is the immediate precursor to testosterone?

Answer 6

androstenedione

Question 7

Contrast the clinical presentation of the two most common forms of congenital adrenal hyperplasia

Answer 7

21- hydroxylase deficiency: presents with addisonian crisis (hypotension, hyperkalemia, hyponatremia)

11-hydroxylase deficiency: hypertension, ambiguous genitalia in females and precocious puberty in males.

Question 8

What is the most common catecholamine associated with pheochromocytoma?

Answer 8

NE (and metabolit normetanephrine)

Question 9

What adrenal androgen is secreted in the highest amount?

Answer 9

DHEA-sulfate…approximately equal secretion to cortisol

Question 10

What is progenolone?

Answer 10

The product of the rate-limiting step adrenal synthesis

Question 11

What enzyme isn’t present in the zona glomerulosa?

Answer 11

17-hydroxylase

Question 12

What are glucocorticoids compared to in equipotency tables?

Which glucodorticoids have low mineralcorticoid activity? Which have high MC activity?

Answer 12

To cortisol (AKA hydrocortisone)

Prednisone and prednisolone have low MC activity and high GC activity

Fludrocortisone has high MC activity, and virtually absent GC activity

Dexamethasone has really high GC activity

Question 13

What is the potency of topical corticosteroids classified according to?

Answer 13

their vasoconstricting potency

Question 14

Where are glucocorticoids metabolized?

Answer 14

the liver, excreted in the urine

Question 15

The HPA axis is considered impaired with what duration of glucocorticoid use?

Answer 15

>2 weeks use in the preceding year

Question 16

What are strategies to minimize iatrogenic Cushings?

Answer 16

Pulse Tx, alternate day thearpy

Question 17

What inhibits glucocorticoid synthesis? GC receptor antagonist?

Answer 17

• aminoglutethimide
• metyrapone
• ketoconazole
• finasteride
• etomidate

mifepristone is a GCR blocker (early pregnancy termination)