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27 Cards in this Set
- Front
- Back
this is the largest zone of the adrenal gland, and is polyhedral, with large number of lipid droplets in cytoplasm
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Zona fasciculata
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What is Cushing Syndrome? Common cause? Other causes?
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Hypercortisolism (increased glucocorticoids)
number one cause: exogenous GCs others: 1° hypothalamic – pituitary diseases associated with increased secretion of ACTH hypersecretion of cortisol by adrenal adenoma, nodular hyperplasia or carcinoma secretion of ectopic ACTH by a nonendocrine neoplasm |
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What can be some of the causes of BILATERAL cortical hyperplasia?
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pituitary adenoma,
ectopic ACTH production, or idiopathic adrenal hyperplasia |
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is malignancy of the adrenal cortex more common in kids or adults?
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adenomas and carcinomas are equally common in adults
carcinomas > adenomas in children |
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levels of cortisol > with carcinoma or adenoma
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CARCINOMA
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if a pt has sky high levels of a hormone, how can you tell if you have an adenoma or carcinoma, considering that both elevate levels
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metastatic disease
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Ectopic secretion of glucocorticoids is most commonly seen with?
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small cell carcinoma of the lung
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VARIOUS FORMS OF CUSHING SYNDROME?
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what are some of the main clinical signs of Cushing syndrome?
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Central obesity – 85-90%
Moon facies – 85% Weakness, fatigability – 85% Hirsutism – 75% Hypertension - 75% Plethora – 75% Glucose intolerance/diabetes 75%/20% Osteoporosis – 75% Neuropsychiatric abnormalities – 80% Menstrual abnormalities – 70% Cutaneous striae – 50% Delayed wound healing |
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this problem in the adrenal cortex causes Na retention, and K excretion...what is it? due to?
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Primary Hyperaldosteronism
80% of time a solitary adenoma is cause (Conn syndrome) |
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What is Conn syndrome?
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80% of time a solitary adenoma is cause of Primary Hyperaldosteronism
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a pt presents with episodic hypertension. After the die, you see a grey-tan color tumor on the adrenal...what is it?
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PHEOCHROMOCYTOMA
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virilization in girls
precocious puberty in boys due to? |
1° gonadal or adrenal disorders
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what are the 3 distinctive syndromes associated with adrenogenital syndrome?
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salt wasting adrenogenitalism – complete absence of hydroxylase activity & resultant mineralocorticoid and cortisol deficiency
--recognized after birth --salt wasting, hyponatremia, hyperkalemia & cardiovascular collapse simple virilizing adrenogenitalism without salt wasting & with incomplete loss of hydroxylase activity nonclassic adrenogenitalism – mild disease which may be asymptomatic or associated only with symptoms of androgen excess during childhood or puberty |
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sudden increase in glucocorticoid requirements in patients with chronic adrenocortical insufficiency can lead to?
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Adrenal insufficiency
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rapid withdrawal of steroids with adrenal suppression 2° to long term glucocorticoid therapy can lead to
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Adrenal insufficiency
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failure to increase steroid doses in adrenalectomized patients during episodes of stress can lead to
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Adrenal insufficiency
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what is Waterhouse--Friderichsen syndrome? more often in what population?
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Uncommon but catastrophic syndrome
overwhelming septicemic infection (usually caused by meningococci – occasionally by pneumococci, gono-cocci, staph) rapid progression to hypotension & shock DIC massive adrenal hemorrhage with insufficiency more often in children - - but may occur at any age ADRENAL INSUFFICIENCY- OVERWHELMING SEPSIS WITH DIC |
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TB can lead to what adrenal problem?
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Adrenal insufficiency (like Addison's)
look for an HIV or immunosuppressed pt |
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Normal cause of adrenal insufficiency?
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AUTOIMMUNE
60 – 70% - adrenals may be the only target – circulating antibodies are present 50% of the time |
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what labs would you expect to find with adrenal insufficiency?
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increased ACTH,
hyperkalemia, hyponatremia, volume depletion |
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how can you distinguish 2ndary adrenocortical insufficiency from primary?
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distinguished from 1° by:
absence of hyperpigmentation normal (or near normal) levels of aldosterone remember a 2ndary may be caused by any disorder of the hypothalamus or pituitary associated with decreased production of ACTH |
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where do adrenal carcinomas met to?
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LUNG
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a pt presents to you with increased corticosteroids/sex steroids. pt has an xray that shows the left kidney has been displaced downward..what is going on
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CORTICAL CARCINOMA
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most medullary disorders are what?
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malignant neoplasms
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undefinable episodic HTN =?
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Pheochromocytoma
associated with catecholamine production & hypertension 85% arise within adrenal medulla 90% occur sporadically; some occur in familial syndromes von Hippel-Lindau von Recklinghausen Sturge-Weber |
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What is the rule of 10 for pheochromocytoma?
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10% occur in children
10% are bilateral 10% occur outside the adrenal gland 10% are malignant 10% are familial (MEN II & MEN III) |