2.2 Cs Exam 1: The Adrenal Gland

Front 1

What are the 3 zones of the adrenal cortex? what does each zone secrete?

Back 1

outer--> inner

sweat--> (during) sweet--> sex

1) zona glomerulosa: mineralocorticoid aldosterone
2) Zone fasciculata: secretes cortisol (GC)
3) Zone reticularis: secretes adrenal androgens (ie DHEA, androstenedione and estrone)

Front 2

what are the causes of adrenal insufficiency ?

Back 2

Autoimmune: addison's (MC- 65%)

infectious
vascular
tumor
infiltrative
congenital
drugs
iatrogenic

Front 3

what are the signs and sxs of acute Adrenal Insufficiency?

Back 3

signs and sxs: weakness, abdominal pain, fever, HA, confusion, N/V/D. Low BP, dehydration, increased skin pigmentation (extensor surfaces), shock

*similar sx to septic shock!!

Front 4

what would you find in laboratory studies in a pt w/ acute adrenal insufficiency?

Back 4

Triad:***
-Hyponatremia
-hyperkalemia

-low BP

Front 5

how do you tx acute Adrenal Insufficiency?

Back 5

hydrocortisone IV w/ saline infusion
empiric antibiotics

Front 6

T/F

You should wait for lab results to being treatment in an adrenal crisis

Back 6

FALSE

Treat ASAP!!

emergency!

Front 7

what are the signs and symptoms associated w/ chronic adrenal insufficiency?

Back 7

arthralgias, myalgias, amenorrhea, sparse axillary hair, incr skin pigmentation (dark spots at birth*)

lab results:

elevated eosinophils,

hyponatremia & hypoglycemia,

hyperkalemia & hypercalcemia

elevated BUN, neutropenia,

lymphocytosis, mild anemia,

low cortisol levels that fail to rise with cortrosyn and elevated ACTH

Front 8

how do you diagnosis chronic adrenal insufficiency?

Back 8

Corsyntropin stimulation test (ACTH)-->

serum evaluation of cortisol 30-60 min later. Cortisol level should rise at least 20 mcg/dl in normal pt.

(Cortisol does NOT rise appropriately)

ELevated ACTH in primary AI.

Low ACTH in secondary AI

Front 9

how do you tx chronic adrenal insufficiency?

Back 9

hydrocortisone (maintain for life)
fludrocortisone
DHEA (if necessary)

Front 10

Congenital Adrenal hyperplasia results from elevated ACTH

This leads to decreased production of ____ & ____

and increased production of ____ & ____

Back 10

decreased--> glucocorticoid & mineral corticoid

increased--> DHEA, androstenedione, progesterone & hydroxyprogesterone

Front 11

4 year old boy presents to your office w/ pubic and axillary hair. You do a blood test and find elevated levels of 17-hydroxyprogesterone, progesterone, DHEA, & androstenedione (converted to testosterone).

Dx and tx

Back 11

21- hydroxylase deficiency

MC Congenital adrenal hyperplasia in which there is a deficit of cortisol and aldosterone. All of the progesterone is converted to testosterone.
confirm dx w/ cortrosyn administration-->

17-hydroxyprogesterone >1500.

( & > 200 before admin)

tx: replace cortisol and aldosterone, evaluate ACTH and androgen levels.

suppress androgens w/ flutamide (aromatase inhibitor (arimadex) to prevent aromatization of testosterone to estrogen)
Spironolactone may be used in late onset disease.

Front 12

what is hyporeninemic hypoaldosteronism? what are the sxs? what causes it? tx?

Back 12

isolated hypoaldosteronism resulting from decreased renin secretion from the kidneys.

sxs: hyper-kalemia & -chloremia. Non gapped metabolic acidosis. Normal sodium w/ hypovolemia. orthostatic hypotension.

causes: NSAID's, ACE-I, and B-blockers

tx: fludrocortisone

Front 13

what is cushing's syndrome?

Back 13

isolated hypersecretion of cortisol or exogenous administration.

ACTH dependant occurs most often (85%); independent (15%)

Front 14

what three types of tumors secrete ACTH that can cause Cushing's?

Back 14

pancreatic, adrenal and thyroid tumors

Front 15

what cancer has a paraneoplastic syndrome that secretes ACTH?

Back 15

small cell lung cancer

Front 16

what are the four causes of ACTH independent cushing's?

Back 16

adrenal adenomas
adrenal carcinomas
micronodular adrenal dz
autonomous macronodular adrenal dz

Front 17

what is cushing's disease as opposed to cushing's syndrome?

Back 17

refers to any cushing's syndrome that is secondary to ACTH producing pituitary tumor only.

Front 18

what are the signs and sxs of cushing's syndrome and disease?

Back 18

central obesity, moon facies, buffalo hump, muscle wasting, thin skin, easy bruisability, psychological changes, hirsuitism, striae, amenorrhea

osteoporosis, HTN, hyperglycemia, leukocytosis, hypokalemia

poor wound healing

Front 19

what lab findings would be indicative of cushings?

Back 19

glucose intolerance
polyuria
elevated ACTH
DM
leukocytosis w/ lymphopenia
hypokalemia w/o hypernatremia

Front 20

how do you dx cushing's?

Back 20

dexamethasone suppression test w/ cortisol level drawn at 8 am. Normal <2 mcg/dl

24 hour urine for free cortisol and cr
midnight serum cortisol > 7.5 mcg/dl; midnight salivary cortisol level >0.25 mcg/dl
also can do inferior petrosal sinus vein sampling.

*Find cause

Front 21

what must the pt stop taking in order to accurately diagnose cushings?

Back 21

all seizure meds and OCPs

Front 22

what is the tx for cushing's dz?

Back 22

remove tumor and then give replacement therapy. or if you can't find the tumor do a b/l adrenalectomy and give an ACTH supressor like ketoconazole, metyrapone or octreotide.

Front 23

What is nelson's syndrome?

Back 23

rapidly enlarging pituitary tumor d/t loss of negative feedback from unopposed ACTH production following B/L adrenalectomy.

--> causes 3rd nerve palsy

*Tx: pituitary supression (tumor removal)

Front 24

what are the signs and sxs of hyperaldosteronism?

(MC d.t adrenal adenoma)

Back 24

HTN, polyuria, polydipsia, muscular weakness, parasthesias, HA, periodic paralysis, hypokalemia, metabolic alkalosis.

Front 25

how do you tx hyperaldosteronism?

Back 25

find tumor
surgical incision
spironolactone for b/l adrenal hyperplasia.

Front 26

what does NE cause? epi? dopamine?

Back 26

NE: alpha agonist- vasoconstriction

epi: beta agonist- positive inotropic and chronotropic effects in the heart, peripheral vasodilation and increasing plasma glucose concentration

dopamine: vasoconstriction.

Front 27

what is a pheochromocytoma? how does it cause HTN?

Back 27

a tumor that is usually in the adrenal medulla (90%), but can be found anywhere along the sympathetic chain (usu mediastinum or abdomen).

Causes paroxysmal HTN d/t excessive amounts of plasma NE

--> headache, diaphoresis, palpitations

--> shock & death

Front 28

how do you tx a pheochromocytoma?

Back 28

remove tumor
alpha and beta blockage to decr catecholamine stimulation