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28 Cards in this Set
- Front
- Back
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most common cause of primary adrenal insufficiency
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autoimmune
often associated with hashimotos, graves, type 1 DM, hypoparathyroidism, hypogonadism |
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what causes hyperpigmentation in addision's disease?
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high levels of ACTH -> high MSH receptor stimulation
melanoocytes are stimulated |
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symptoms of addison's disease
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salt craving, polyuria, low sodium, high potassium, metabolic acidosis, elevated BUN (due to low aldosterone)
fatigue (low cortisol) hyperpigmentation |
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treatment of addisons disease
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hydrocortisone to replace cortisol
florinef to replace aldosterone |
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addision's is associated with what other diseases
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alopecia areta
vitiligo chronic mucocutaneous candidiasis other autoimmune disease - hashimotos |
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congenital adrenal hyperplasia
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21-OH deficiency
increased sex hormones decreased aldosterone decreased cortisol hyperplasia of adrenal gland due to high levels of ACTH due to lack of neg feedback by cotrisol |
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genetalia of males with CAH will be?
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normal
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genetalia of females with CAH will be?
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virilized
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SRY gene
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on the Y chromosome
promotes testes formation and formation of wolffian duct degenerates the mullerian ducts |
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T/F ovaries can develop normally with one X chromosome
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false - need two X chromosomes
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symptoms of 21 OH deficiency in males
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failure to thrive
vomiting/dehydration, shock won't live long compared to female |
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how to screen for 21 OH deficiency
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look for high levels of 17 hydroxyprogesterone
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whats the bone age of a patient with CAH who is 6 but as tall as his 12 year old brother?
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12
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why are testes small in males with precocious puberty in CAH
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small testes because androgen not coming from testes
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symptoms of cortisol deficiency
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weakness, fatigue, hyperpigmentation (due to high ACTH), hypoglycemia, postural hypertension
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symptoms of aldosterone deficiency
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renal Na wasting, K+ retention -> hyponatremia, hyperkalemia
nausea vomiting polyuria salt craving postural hypertension, metabolic acidosis shock DEATH |
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when do you need to increase dose of cortisol for patients with CAH
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fever, injury
surgery vomiting |
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2ndary adrenal insufficiency
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ACTH deficiency due to CNS tumor, congenital, hypothalmic-pituitary supressiong secondary to exogenous steroids
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how long do you need to recover from adrenal atrophy due to corticosteroid use?
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6 months
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primary vs 2ndary adrenal insufficeincy symptoms
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no salt wasting or hyperpigmentation with 2ndary adrenal insufficiency
salt retention is controlled by Renin-angiotensin system not ACTH low ACTH means no hyperpigmentation |
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diagnosis of 2ndary adrenal insufficiency
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low cortisol
low ACTH low AM cortisol low response to cortrosyn, metyrapone, hypoglycemia |
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causes of cushing syndrome
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excess pituitary ACTH (cushing disease - due to primary adenoma)
ectopic ACTH adrenal cortical tumor iatrogenic - due to steroid use |
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symptoms of cushing syndrome
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truncal obesity
moon face buffalo hump easy bruising straie hypertension osteoporosis growth supression |
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distinguishing between ACTH secreting pituitary tumor and excessive cortisol secretion
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24 hour urine free cortisol
overnight dexamethasone supression test |
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disorders of renin-aldosterone system
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renal disease -> increased renin and aldosterone
primary hyperaldosteronism - Conn's syndrome |
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abnormal urine free cortisol with an ACTH undetectable and no effect high dose dexamethasone supression
what is the cause of cushing's syndrome in this case? |
indicates adrenal tumor secreting cortisol
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abnormal urine free cortisol with an ACTH elevated and no effect of high dose dexamethasone supression
what is the cause of cushing's syndrome in this case? |
ectopic ACTH
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abnormal urine free cortisol with an ACTH normal/slightly elevated with <50% supression after high dose dexamethasone
what is the cause of cushing's syndrome in this case? |
cushing disease
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