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DU PA Adrenal Patho
Duke PA Adrenal Pathophysiology
| Question | Answer |
|---|---|
| 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
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