adrenal gland Flashcards


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created 7 days ago by Rereih
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1

cortex hormones

  • glucocorticoids
  • mineralocorticoids
  • androgens

2

medulla hormones and cells

chromaffin cells

  • catecholamines (epi and nor epi)
  • bioactive amines and peptides (histamine, serotonin, neuropeptides)

3

adrenal hyperfunction is caused by

compensatory - congenital adrenal hyperplasia

acquired - hyperplasia or adenomas or adenocarcinomas

4

Addison etiology

  1. idiopathic (70%)
  2. destruction by (granuloma, tumor, amyloidosis, hemorrhage, inflammation)
  3. drugs (ketoconazole)
  4. polyglandular deficiency syndrome
  5. congenital adrenal hyperplasia (children)

5

Addison pathophysiology

  1. mineralocorticoids deficiency > high K low Na > dehydration, hypotension, acidosis, collapse
  2. glucocorticoids deficincy > hypotension, hypoglycemia, infections, dehydration, myocardial weakness, collapse.

6

hyperpigmentation pathophysiology

low cortisol levels > ACTH production > increased production b- lipotropin > melanocyte stimulation

7

diagnosis of addison

  1. signs and symptoms
  2. high ACTH
  3. low cortisol levels
  4. low Na <135
  5. high k <5
  6. low HCO3 15-20
  7. high BUN

8

ttt of addison

  • hydro cortisol
  • fludrocortisone
  • prednisone

9

adrenal crisis chart.

  1. sever pain
  2. peripheral vascular collapse
  3. renal shutdown with azotemia
  4. temperature
  5. under physiological stress
  6. shock and fever

10

adrenal crisis ttt

  1. hydrocortisone
  2. iv saline
  3. k replacement
  4. underlaying cause

11

seconder adrenal insufficiency diagnosis

  • low ACTH
  • low cortisol
  • ACTH stimulation testing
  • CNS imaging

12

causes of secondary adrenal insufficiency

  1. panhypopituitaism
  2. isolated ACTH production failure
  3. reciving corticocteroids for > 4 weeks
  4. after stopping corticosterids therapy
  5. adrenal unresponsive to ACTH due to atrophy

13

differences between the secondary and primary

  1. secondary have the following
  2. less hypovolemic
  3. no hyperpigmentation
  4. normal electrolytes, normal bun
  5. not treated with fludrocortisone

14

etiology of ACTH dependent Cushing

  • ACTH hyper secretion by pituitary adenoma
  • non pituitary tumor (ectopic ACTH syndrome)
  • exogenous ACTH

15

etiology of ACTH independent Cushing

  • corticosteroids
  • adrenal adenoma
  • adrenal carcinoma

16

diagnosis of cushing

  • signs and symptoms
  • pituitary imaging studies
  • dexamethasone suppression test
  • urinary free cortisol levels
  • ACTH
  • Cortisol serum at midnight
  • salivary cortisol

17

ttt of cushing

  • ketoconazole
  • surgery or radiation
  • high protein diet
  • k administration

18

secondary aldosteronism

  • high aldesterone
  • renal artery stenosis
  • hypovolemia

19

pheochromocytoma

definition

diagnosis

ttt

  • tumor in the chromaffin cells> secret catecholamines
  • causes persistent paroxysmal hypertension
  • testing catecholamines levels
  • imaging ct mri
  • remove tumor & b blockers to control bp