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DU PA Adrenal Patho

Duke PA Adrenal Pathophysiology

outer zone of adrenal cortex zona glomerulosa
middle zone of adrenal cortex zona fasciculata
inner zone of adrenal cortex zona reticularis
innermost portion of the adrenal gland adrenal medulla
outer portion of the adrenal gland adrenal cortex
major mineralocorticoid aldosterone
aldosterone is made in the zona glomerulosa
__ stimulates renal tubule reabsorbtion of sodium and excretion of potassium
major glucocorticoid cortisol
cortisol is made in the zona fasciculata
cortisol counters the effects of insulin
cortisol has a __ secretory pattern diurnal
cortisol secretion is highest in the morning
cortisol is anti-__ inflammatory
__ is elevated in exercise and stress cortisol
androgens are made in the zona reticularis
Dysfunction at the level of the adrenal gland by a local lesion or disease process PRIMARY Adrenal Insufficiency (AI)
AI from the level of the pituitary gland -> inadequate ACTH secretion SECONDARY Adrenal Insufficiency
AI from the level of the hypothalamus -> interference w/ CRH secretion SECONDARY Adrenal Insufficiency
Involves all 3 zones of the adrenal cortex- ie (usually) a deficiency in glucocorticoid as well as mineralocorticoid and androgen Addison's disease
hyperpigmentation due to excess ACTH is only seen in __ AI primary
long term exogenous cortisol therapy can lead to __ secondary AI
AM cortisol > or = __ is a normal result and rules out AI 18
AM cortisol < or = __ is a positive result and rules in AI 3
AM cortisol in the range of 3-18 needs __ dynamic testing
if you have ruled in AI by either a low AM cortisol or subnormal ACTH response check the __ plasma ACTH level
HIGH (endogenous) ACTH: Levels > 100 would be consistent with __ AI primary
A normal ACTH level (between 5 - 45 pg/ml) effectively rules out __ AI primary
In adrenal crisis __ do not wait for pending lab results before beginning empiric treatment in crisis
In adrenal crisis __ treat with IV dexamethasone 4mg, or IV hydrocortisone 100mg
In adrenal crisis __ is preferred because it won’t interfere w/ further diagnostic testing and is long acting dexamethasone
If AI is truly primary there is not only a cortisol deficit but __ deficit as well an aldosterone
In primary AI, to fix the aldosterone deficit treat with __ fludrocortisone
With AI prior to surgery __ hydrocortisone dose increase
Refers specifically to an ACTH secreting pituitary adenoma with resultant cortisol secretion Cushing's Disease
General term for hypercortisolism at any level including adrenal, ectopic, or pituitary source Cushing's Syndrome
Diagnosis of Cushing's syndrome involves a __ 24-hour urine free cortisol
increased hair growth (chin, upper lip, abdomen, chest) hirsutism
Polycystic Ovarian Syndrome can lead to Hirsutism and Virilization
refers to the biological development of sex differences, changes which make a male body different from a female body virilization
menstrual irregularity, infertility, androgen excess, hirsutism, and sometimes obesity and insulin resistance Polycystic Ovarian Syndrome
abrupt onset of Hirsutism and Virilization is an indication of an androgen-secreting adrenal carcinoma
Life long problem with hirsutism and virilization is an indication of __, and is also the rarer form Androgen-secreting adrenal adenomas
Enzymatic defects in the adrenal steroid hormone synthesis pathways leading to: inadequate cortisol +/-mineralocorticoid, classically with an associated androgen excess Congenital Adrenal Hyperplasia
mucle symptoms due to hypokalemia cramping, weakness, periodic paralysis
Clinical findings of primary hyperaldosteronism hypertension, muscle symptoms (due to hypokalemia. Often there are few clinical findings at all.
with primary hyperaldosteronism there will be high aldosterone but low __ renin
a patient with primary hyperaldosteronism will have metabolic __ alkalosis
Primary Hyperaldosteronism. Solitary/Unilateral Aldosterone-Producing Adenoma Conn's Syndrome
the adrenal medulla produces __ catecholamines
epinephrine, norepinephrine, dopamine catecholamines
clinical findings of pheochromocytoma the five P's:Pain (headaches), Pallor (orthostatic hypotension), Palpitations (catecholamine release), Pressure (hypertension), Perspiration
Created by: bwyche