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21 Cards in this Set
- Front
- Back
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Normal role of Cortisol in stress times?
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Increases --> catabolic activity and release of AA's to make more glucose to make sure there is enough glucose for CNS during stress
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Sites of protein breakdown from cortisol and result of too much breakdown?
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Skeletal Musc-proximal weakness
Skin and SC tissues: plethora, striae, easy bruising Bone: osteoporosis, fractures, back pain |
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Kicker for Cushing's Striae?
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Purple stretch marks
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Other pathologic fxns of hypercortisol?
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-Suppresses cell-mediated immune response
-Inc glucose--> inc insulin --> fat deposition in hump and supraclavicular fossa -in CNS -->neuropsychiatric issues -Inc mineralcorticoid action-->HTN and hypokalemia -Inc androgens --> hirsutism, menstrual issues |
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Causes of Cushing's Syndrome?
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Pituitary (Cushing's disease)
Adrenal Source (carcinoma/adenoma) Ectopic ACTH Ectopic CRF (very rare) |
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Clinical Kickers for Cushing's Syndrome?
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Easy Bruising
Moon Facies Striae (purple) Fat pads Hirsutism HTN Hyperglycemia Hypokalemia |
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What leads to Clinical Suspicion of Cushing's?
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Recent Wt Gain
Striae (wide and purple/red) Osteopenia (at early age) Supraclavicular fat pad Proximal Musc Weakness |
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Screening Technique for Cushing's?
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Random serum cortisol ain't helpful
Classic test: overnight low dose dex suppression test 24-hr Urinary Cortisol Elevated Midnight Cortisol (staple of Cushing's) |
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How do you figure out Cushing's Etiology?
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Measure ACTH
-if low--> think ACTH-indep and adrenal source (carcinoma/adenoma) -if its high, think ACTH dep and Pituitary (adenoma) or Ectopic Source (neoplasm) |
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Typical Ectopic sources of ACTH?
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Small Cell Lung Cancer
Carcinoid Syndrome (lung/gut) Islet Cell Tumor of pancreas Pheochromocytoma |
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How do you decide between pituitary or ectopic source of ACTH?
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High Dose Dex suppression test
Should get a 50% reduction in AM cortisol w/ pituitary adenoma |
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Definition of Adrenal Insufficiency
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Relative/Absolute Def of circulating glucocorticoids and mineralcorticoids
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What is Primary Adrenal Insufficiency?
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Addison's Disease = destruction or metabolic inhibition of adrenal gland activity
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Causes of Addison's?
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Autoimmune Adrenalitis (80%)
TB (19%) Other (1%) |
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Cause and findings w/ secondary Adrenal Insufficiency?
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Inc Pituitary ACTH --> different presentation than primary b/c of preserved mineralcorticoid synthesis and release
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Presentation of Acute Adrenal Insufficiency?
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Usually w/ other illness
Volume Contraction Hypotension Electrolyte abnormality |
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Presentation of Chronic Adrenal Insufficiency?
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More typical of Addison's
H/O wt loss weakness fatigue anorexia postural dizziness N/V Hypotension HA Neuropsych illness Salt Craving** |
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Physical Findings w/ Adrenal Insuff?
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Maybe Cachectic
Hypotension w/ marked orthostatic changes **Inc skin Pigmentation (addison's only) Volume Contraction |
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Lab findings w/ Adrenal Insuff?
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Hyponatremia
Hyperkalemia Hypoglycemia maybe hypercalcemia metabolic acidosis lymphocytosis and eosinophilia |
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Dx of Adrenal Insufficiency?
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H&P
Rapid ACTH Stimulation Test (cortosyn injection. should inc by at least 10 for normal) |
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How do you sort out primary vs secondary Adrenal Insufficiency?
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Clues
Coexistant Pituitary Disease Pigmentation (primary) Hyperkalemia (primary) Severe hypotension (primary) Cosyntropin ACTH stim test (flat response = primary, dec response = secondary) Insulin Tolerance Test (will cause hypoglycemia/stress, which should lead to amped ACTH, but won't be seen in secondary) |
