Term
| adrenal gland order from out to inside |
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Definition
| glomeulose, fasiculata, reticularis- salt sugar sex- minerlicoridtoicds, glucocorticoids,adnrogens. |
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Term
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Definition
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Term
| signs symtposm of cushigns sydnrome |
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Definition
diabetes**, hypertension** (weak mienralicorticoid and glucocorticoid , excluding aldosterone), central obesity** (due to hyperinsulinemia), skin abnormaliteis (violaous striae most specific), hirsuitism**, myopathy, osteoperosis, and icnresased infections
musclewasting and thin extreimties** |
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Term
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Definition
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Term
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Definition
| crh from hypothalamus to actch form pituitary cortisol feedback inhbiits acth and crh |
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Term
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Definition
circadian pattern - highest levels are in am follwoing acth release
increased coritosl produciton:
physiological: stress excercise, pregnancy.
patholgoical: psuedo cushings (continous stress all the time pyhysiolgoical state 24/7), acth depepndant andi ndepepndant, and exogenosu soruces |
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Term
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Definition
| hyperactiation at the hypothalamus levels icnreased crh increases acth and increased cortisol |
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Term
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Definition
excercise pregancny, ucntonroleld diabetes, alcohlism, extreme obesity, slepe apnea, pain, stress, psychiatric disorders
-if person has nay of these factors do not oeprate on pituitary, try and alleviate problems of origin first. |
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Term
| screening tests for cushings syndrome |
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Definition
| urine free cortisol, dexamethasonesupression, midnight coritosl- shoudlbe low, |
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Term
| msot common cuase of cushings syndrome |
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Definition
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Term
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Definition
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Term
| acth indepdnat cushings syndrome |
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Definition
| adrenal adenoma, adrenal carcinoma, micronodular and macronodularh yperlasisa |
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Term
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Definition
| crh stimaultion test, hgih dose dexamehasoen supression test, or bilateral inferior petrosal snus screening. |
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Term
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Definition
| will supress pituiatry secertion b,ut nto ectopci rpdocution |
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Term
| common ectopicacth tumors |
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Definition
| small cell carcinoma of the lung, and thymomas. |
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Term
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Definition
| mineralicorticoid excess. |
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Term
| etiology of conn's syndrome |
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Definition
| mostly aldosterone productin adernel admeonoma, however can be adrenal hyperlpasia or adrenal carcinoma |
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Term
| clincal presnetaiton of conn's sydnrome |
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Definition
| hypokalemia hyeprtension , metabolic alkalosis. (when potassium is depleted, protons are exchanged for sodium instead) |
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Term
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Definition
| has nothign to do with HPA axis, under rAAS system contorl |
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Term
| primary hyperaldoseteronism diagnosis |
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Definition
| elevated aldosterone to renin ratio. do salt loading (which should suppres aldosterone) to confirm. |
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Term
| Treatment primary hyepraldosteronism |
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Definition
unilateral adenoma- surgical resection.
bilateral hyeprplasia mediacl therapy. |
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Term
| medical therapy of hyepraldosternoism |
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Definition
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Term
| Adrenal inssuficeincy : primary vs. secodnary |
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Definition
| you lose minerlicoritocid in primary but not in secodnary. |
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Term
| diagnosis of adrenal insuficciency |
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Definition
| mornign coritsol elvels, ACTH stimualtion test. |
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Term
| hyperpigmentation is a sing of |
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Definition
| primary adrenal inssuciecny |
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Term
| signs fo adrenal isnsfuiceicny |
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Definition
| weight loss , hyponatermia, hyperkalemia (primary) , vitiligo (autoimmune asosciated comorbied with addisons), hypoglycemia |
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Term
| cortisol deficiency symtpoms |
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Definition
| weight loss, fatigue , anorexia, GI complaitns |
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Term
| mineralicorticoid defiency |
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Definition
| inability to conserve sodium or excrete potasisum- hyponatreia nad hyperkalemia, dehydration hypotension |
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Term
| lack of adrogenic steroids sign |
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Definition
| lack of ax and pubic hair in women |
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Term
| most common etiology of primary adrenal insuficciency |
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Definition
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Term
| other causes of adrenal insufficiency |
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Definition
| hemorhage, ifnectious , waterhosue-fredrichson, metastatic disease, drugs, familial |
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Term
| hyperpigmentation etiology , and areas ofh yperpigmetnaiton |
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Definition
addisons disease acth overproduciton leads toh yeprpigemntation sicne first few residues are identical to melanocyte stimuatlign hormone.
hyperpigmented mouth, flexor surfaces of hands and nailbeds. |
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Term
| secodnary adrenal insuficciency msot common cause |
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Definition
feedback from exogenous sstreoids (i.e. cortisol like)
can also be caused by surgery or pituiary/hypothalamic disease |
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Term
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Definition
| sever adrenal insufficiency: shock state: fever hypotension vomitting , hypoglycemia, renal failure. |
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Term
| treatmetn of adrenal crisis |
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Definition
| IV fluid replacement, glucorticoid and Mineralicorticoid rpelacemnt |
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Term
| causes of pheochromocytoma (adrenal medullary disrodsder) |
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Definition
can be benign or malignant, can be present in Goljan: Men 2a or men 2b. , or von hippel lindau- renal carcinoma, or neurofibomatosis
von hipple-lindau- renal carcinoma. |
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Term
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Definition
| medullary cancer of the thyroid, with hyperparathyroidism and pheochromocyotma. (and marfanoid appearance) |
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Term
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Definition
| neurognagliomas of the gonue, and pheochromocytoma. |
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Term
| epidemiolgoy fo pheochromocytoma |
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Definition
| 10 percent extra darenal 10 percent malignant , 10 percent children, 10 percent recur. 10 percent familal, |
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Term
| the classcial triad of pheochromocytoma |
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Definition
| pain (headache), palpiatations, perspiration (and paroxysms- spells lasting 15-20 min in duraiton, spontaneous). |
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Term
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Definition
| look for urine and plasma metanierphine, and venedmelic acid (VMA) |
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Term
| prepartion for phechormocytoma srugery |
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Definition
| ALlpha blockade FIRST (to vasodilate adn prevent severe hypertension), followed by beta blockade. so when pheochromocytoma spits out catecholamiens hwen touched, it will not effect anything |
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Term
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Definition
| incidentally foudn on imaging alot, can be benign cortical secreting adenomas/aldosterone secreting, pheochromocytoma, aldosterone or adrenocortical carcinoma, |
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Term
| diagnostic workup of adrenal masses |
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Definition
| screen for cortisol, screne for pheochromocytoma screen for hyepraldosteronism |
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Term
| adrenocritocal carcinoma features |
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Definition
| usually emtastazied at time of diagnosis, heyrpsecretes.frequently |
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Term
| enzyme pathway adrenal precursos |
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Definition
| choelsterol to pregneloen to progesterone |
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Term
| congential adrena hayperplasia pathogenesis |
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Definition
deficiencies in mienralicorticoid and coritsol pathway.
Due to reduced coritsol feedback (mai fneedback mechanism) ACTH production is increased, eladign to Adrenal hyperplasia. leds to overproducitn of androgens, sicne they precede the blcok |
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Term
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Definition
all autosomal recessive.
classic- present at brith
nonclasic- dianogsed later in life |
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Term
| most common CAH , and diagnosis |
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Definition
| 21 hyrdoxylase deficiecny , high serum 17 hydroxyprogesterone |
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Term
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Definition
| virilzation in females (including ambigious genitalia)and early virilziation i males, salt wasting , if aldosterone is blockd as well ( it is in 21 hydroxylase deficiency |
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Term
| salt wasting in CAH occurs in |
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Definition
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Term
| gojlan:msot common overall caue of adrenocortical insufficiency |
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Definition
| acute withdrawal of glucocritcoids (for primary most ocmmon cauase is automimmuen) |
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Term
| waterhouse friedrichesin sydnrome |
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Definition
| adrena lhemmroahge due to DIC , secondary to sepsis form mentigitidis |
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Term
| goljan: msot common cause of chronci adrenal insufficiency in devleoping countires |
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Definition
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Term
| goljan: main effecst of glucoritociods in adidsonsdisease |
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Definition
| decreased glucorticoids = lymphocytosis, eosonophilia, andh ypoglycemia |
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Term
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Definition
| bilateral adrenalectomy cuases increae in pituiataryadenoma size due to decreased cortisol feedback inhibition |
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