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Adrenal 3


HTN not responsive to meds Renal artery stenosis (Infrarenal artery)
HTN w/ hypernatremia, hypokalemia Primary Aldosteronism
Tetany, carpopedal spasm, hypocalcemia, cataracts; Chvostek & Trousseau sxs Hypoparathyroidism
Exogenous corticosteroid use Cushing syndrome
Dexamethasone suppression test Cushing syndrome
Central obesity, abdominal stria, hyperglycemia, moon facies, buffalo hump, easy bruising Cushing syndrome
Acute steroid withdrawal Addison dz, crisis
Hyperpigmentation, hypoglycemia, orthostatic hypotension, hypotension not responsive to fluids, hypotension following an illness, trauma, or surgery Addison dz, crisis (Low aldosterone; get Random or AM cortisol, ACTH stimulation test)
Worsening fatigue, wt loss, weakness, recurrent abdominal pain, hair loss, hyperpigmentation. Hyponatremia, hyperkalemia Addison dz, crisis (Low aldosterone; get Random or AM cortisol, ACTH stimulation test)
Hyponatremia, hyperkalemia Acute adrenal insufficiency (Addison crisis)
Polyuria (to 12 L/day), polydipsia. Dilute urine, Hypernatremia Diabetes insipidus
Concentrated urine. Hyponatremia SIADH
45, X – low hairline, low set ears, webbed neck, short stature; shield chest, wide set nipples, infertility, lack of Secondary sex characteristics Turner (gonadal dysgenesis
XXY male - short stature, low intelligence; small firm testes, gynecomastia, abn arm-body length Klinefelter (hypogonadism)
Adrenal Insufficiency (AI) is: Cortisol Deficiency
Primary Adrenal Insuff = Addison Dz; adrenal gland does not respond to ACTH & not make adrenal hormones; 80% 2/2 autoimmune destn of adrenal cortex
Secondary Adrenal Insuff = Pit does not make ACTH; adrenal is not stimulated to make cortisol
Tertiary Adrenal Insuff = Suppression of CRH & ACTH by exogenous cortisol use
Primary Adrenal Insuff: Sx Fatigue, hyponatremia, Hyperkalemia; ortho hypotension; delayed DTRs; Hyperpigmentation (from ACTH, only in primary AI);
Secondary adrenal insuff & RAAS b/c secondary & tertiary adrenal insuff only involve low ACTH levels, the RAAS is still intact; Only cortisol is deficient.
Secondary adrenal insuff: Sx Hyperkalemia & Hypotension are rarely seen; hyperpigmentation is not seen
Hypogonadotropic Hypogonadism = F: Amenorrhea/Infertility; M: Erectile Dysfunction/ Infertility; Inappropriately Low FSH/LH for low estrogen or testosterone
Hypogonadotropic Hypogonadism: Eval MRI Pituitary to assess for cause; Labs [prolactin; Iron/TIBC (Hemachromotosis); if estrogen level low, do Provera challenge]
Diabetes Insipidus = No ADH; unable to conc urine; Polyuria; Polydipsia (esp night); UOP: 5-20 L / d; U spec grav < 1.0006; Hypernatremia; Normal Glucose
Diabetes Insipidus: Water Deprivation Test Follow every 1-2 hrs: Na; UOP, Urine Osmo; Wt; BP & HR (Lying / Standing); Once serum osm >300 & urine osm has not increased, give 10 ug of vasopressin and follow urine osm
Water Deprivation Test: purpose distinguish btw central and nephrogenic DI
Water Deprivation Test: Nephrogenic: give AVP, kidney won’t respond, urine remains dilute
Causes of Diabetes Insipidus Panhypopituitarism; Sarcoidosis/ Infiltrative Dz; Tumor; Trauma
Sx of Hypopituitarism Secondary Hypothyroidism; Hypocortisolism (secondary adrenal insuff); Amenorrhea, Menopause, Erectile Dysfunction, Infertility; Polyuria/Polydipsia
Hyperprolactinemia: Sx (Women) Galactorrhea; Amenorrhea; Infertility
Hyperprolactinemia: Sx (Men) ED; Infertility; HA; Mass Effect (eg, from tumor in head); Galactorrhea (Pathognomonic)
Prolactinoma: tx w/ Dopaminergic Drugs if: Macroadenoma; Mass Effect; Visual Field Deficit; Fertilty Desired
Prolactinoma: tx w/ Hormone Replacement if: No Fertility Desired; Microadenoma; Visual Field Full; No Mass Effect; Estrogen or Testosterone is low
Acromegaly vs Gigantism Acromeg: pit tumor secreting GH in adulthood; Gigantism: pit tumor secreting GH during PUBERTY before epiphyseal plate fusion; rapid linear growth, heights up to 8ft 11 in
Risks of LT exposure to GH include: Arthropathy, neuropathy, CVD; HTN; resp dz; malig; CHO intol/DM
When to Suspect Acromegaly MEN-1/other FH; Prominent brow; enlarged soft tissue of hands/ft, doughy handshake; splayed teeth, macroglossia; DM; HTN/ LVH;
Cushing syndrome XS cortisol prodn; Exogenous (Use of synthetic Glucocorticoids); Endogenous = Cushing Dz; poss 2/2 adrenocortical tumor or nonpit ACTH-producing tumor (eg, SCLC)
Cushing syndrome: Sx DM; HTN; Osteoporosis; Psychosis; Easy Bruising; central Obesity; Hyponatremia; Moon Facies; Buffalo Hump; prox Mx Wasting/weakness; Hirsutism; Purple Striae; Supraclavicular Fat; Infections; amenorrhea
Cushing Dz may be due to: Pit ACTH overprodn; Ectopic ACTH Prodn; or Pit/Adrenal Adenoma producing cortisol
Cushing Dz: endogenous cortisol excess: 75-80 % of cases; elevated cortisol levels do not suppress hypothalamic & ant pit secretion of CRH & ACTH
Ectopic ACTH production = Nonpituitary Tumors secrete ACTH and do not respond to negative inhibition of high cortisol levels
Ectopic ACTH production poss d/t: Small Cell Lung Ca; Carcinoid Tumors; Pheochromocytoma; Thymoma; Pancreatic Cell tumors; Medullary Ca of the Thyroid
Adrenal Hypercortisolism ACTH & CRH are suppressed; Caused by: Adrenal Adenomas; Adrenal Ca; Micronodular or Macronodular Hyperplasia
Lack of stimulating hormone: causes Pituitary (PanHypopituitarism); Hypothalamus (Stress, Tumor)
Hyperfunctioning of Endocrine Gland Autonomous Fn of Primary Gland (Thyroid Toxic Adenoma); Autonomous Fn of Gland making Stim Hormone (Cushing Dz: ACTH); Ab’s that Stim Hor Receptor (Graves / TSI); Ectopic Prod Stim Hormone (Ectopic ACTH)
Hypercalcemia S/S serum Ca >10.5 mg/dL; altered mentation, N/V; polyuria, polydipsia, stones
Created by: Adam Barnard Adam Barnard