Endocrine: 11. Leech : Adrenal Pathophysiology And Pharmacology

Front 1

this is the largest zone of the adrenal gland, and is polyhedral, with large number of lipid droplets in cytoplasm

Back 1

Zona fasciculata

Front 2

What is Cushing Syndrome? Common cause? Other causes?

Back 2

Hypercortisolism (increased glucocorticoids)

number one cause: exogenous GCs

others:
1° hypothalamic – pituitary diseases associated with increased secretion of ACTH
hypersecretion of cortisol by adrenal adenoma, nodular hyperplasia or carcinoma
secretion of ectopic ACTH by a nonendocrine neoplasm

Front 3

What can be some of the causes of BILATERAL cortical hyperplasia?

Back 3

pituitary adenoma,
ectopic ACTH production, or idiopathic adrenal hyperplasia

Front 4

is malignancy of the adrenal cortex more common in kids or adults?

Back 4

adenomas and carcinomas are equally common in adults

carcinomas > adenomas in children

Front 5

levels of cortisol > with carcinoma or adenoma

Back 5

CARCINOMA

Front 6

if a pt has sky high levels of a hormone, how can you tell if you have an adenoma or carcinoma, considering that both elevate levels

Back 6

metastatic disease

Front 7

Ectopic secretion of glucocorticoids is most commonly seen with?

Back 7

small cell carcinoma of the lung

Front 8

VARIOUS FORMS OF CUSHING SYNDROME?

Back 8

Front 9

what are some of the main clinical signs of Cushing syndrome?

Back 9

Central obesity – 85-90%
Moon facies – 85%
Weakness, fatigability – 85%
Hirsutism – 75%
Hypertension - 75%
Plethora – 75%
Glucose intolerance/diabetes 75%/20%
Osteoporosis – 75%
Neuropsychiatric abnormalities – 80%
Menstrual abnormalities – 70%
Cutaneous striae – 50%
Delayed wound healing

Front 10

this problem in the adrenal cortex causes Na retention, and K excretion...what is it? due to?

Back 10

Primary Hyperaldosteronism

80% of time a solitary adenoma is cause (Conn syndrome)

Front 11

What is Conn syndrome?

***

Back 11

80% of time a solitary adenoma is cause of Primary Hyperaldosteronism

Front 12

a pt presents with episodic hypertension. After the die, you see a grey-tan color tumor on the adrenal...what is it?

Back 12

PHEOCHROMOCYTOMA

Front 13

virilization in girls
precocious puberty in boys

due to?

Back 13

1° gonadal or adrenal disorders

Front 14

what are the 3 distinctive syndromes associated with adrenogenital syndrome?

Back 14

salt wasting adrenogenitalism – complete absence of hydroxylase activity & resultant mineralocorticoid and cortisol deficiency
--recognized after birth
--salt wasting, hyponatremia, hyperkalemia & cardiovascular collapse

simple virilizing adrenogenitalism without salt wasting & with incomplete loss of hydroxylase activity

nonclassic adrenogenitalism – mild disease which may be asymptomatic or associated only with symptoms of androgen excess during childhood or puberty

Front 15

sudden increase in glucocorticoid requirements in patients with chronic adrenocortical insufficiency can lead to?

Back 15

Adrenal insufficiency

Front 16

rapid withdrawal of steroids with adrenal suppression 2° to long term glucocorticoid therapy can lead to

Back 16

Adrenal insufficiency

Front 17

failure to increase steroid doses in adrenalectomized patients during episodes of stress can lead to

Back 17

Adrenal insufficiency

Front 18

what is Waterhouse--Friderichsen syndrome? more often in what population?

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Back 18

Uncommon but catastrophic syndrome

overwhelming septicemic infection (usually caused by meningococci – occasionally by pneumococci, gono-cocci, staph)

rapid progression to hypotension & shock
DIC
massive adrenal hemorrhage with insufficiency
more often in children - - but may occur at any age

ADRENAL INSUFFICIENCY- OVERWHELMING SEPSIS WITH DIC

Front 19

TB can lead to what adrenal problem?

*

Back 19

Adrenal insufficiency (like Addison's)

look for an HIV or immunosuppressed pt

Front 20

Normal cause of adrenal insufficiency?

Back 20

AUTOIMMUNE

60 – 70% - adrenals may be the only target – circulating antibodies are present 50% of the time

Front 21

what labs would you expect to find with adrenal insufficiency?

Back 21

increased ACTH,
hyperkalemia,
hyponatremia, volume depletion

Front 22

how can you distinguish 2ndary adrenocortical insufficiency from primary?

Back 22

distinguished from 1° by:
absence of hyperpigmentation
normal (or near normal) levels of aldosterone

remember a 2ndary may be caused by any disorder of the hypothalamus or pituitary associated with decreased production of ACTH

Front 23

where do adrenal carcinomas met to?

Back 23

LUNG

Front 24

a pt presents to you with increased corticosteroids/sex steroids. pt has an xray that shows the left kidney has been displaced downward..what is going on

Back 24

CORTICAL CARCINOMA

Front 25

most medullary disorders are what?

Back 25

malignant neoplasms

Front 26

undefinable episodic HTN =?

*** TEST

Back 26

Pheochromocytoma

associated with catecholamine production & hypertension
85% arise within adrenal medulla
90% occur sporadically; some occur in familial syndromes
von Hippel-Lindau
von Recklinghausen
Sturge-Weber

Front 27

What is the rule of 10 for pheochromocytoma?

Back 27

10% occur in children
10% are bilateral
10% occur outside the adrenal gland
10% are malignant
10% are familial (MEN II & MEN III)