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