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Week 22 - Adrenal issues and dx
Terms in this set (26)
Cushings which is an excess production of cortisol, Addisons which is a deficiency of adrenal function, pheos states affect NA and adrenaline production
What are the two broad disease states of the adrenal cortex? The one of the medulla?
Exactly the same as cortisol just what we name pharmaceutical replacements of it, an inactive metabolite of cortisol which can be remetabolised back into active cortisol in the liver
What is the hydrocortisone? What is cortisone and why still given as a pharmaceutical then?
Each pathway shares some enzymes, mineralcorticoid pathway can be shunted into either gluc or androgens, gluc into androgens only
Although complicate what is shared across the steroid synthesis pathway? How can they be shunted?
Stimulation of gluconeogenesis, mobilisation of amino acids from muscles, stimulation of lipolysis, immunosuppression
What are the four major effects of glucocorticoids? (Think liver, muscles, fat, immue ssytem)?
Central adiposity, muscle wasting leading to thin limbs, hyperglycaemia and potentialy diabetes, skin and bone wasting, hypertension from salt retention and growth inhibition
What are some key consequences of excess cortisol (chronically)?
ACTH dependent due to issues in pituitary usually an adenoma or ectopic ACTH production (Cushings disease), ACTH independent due to tumor in adnrelas or just hyperplasia or GCS drugs (Cushings syndrome)
What are the two broad categories of hypercortisolism and how they are split into cushings disease or syndrome?
Rounded face and redness, hirsutism in females
What are three key facial features of cushings?
WIll get striations due to being able to see blood vessels, back fat pad, suppression of growth
What is an iconic cushings feature on skin? Behind head? If it occurs in childhood?
Always test for hormones first which needs to be repeated and measure multiple connected factors either tropic and hormone or hormone/tropic and factor it regulates
What is the frontline testing for suscepted hormon issues and what are the ekys to effective testing ehre?
Use low dose dexamethasone to see if ACTH can be suppressed, if not move to high dose, still not surpressed is probably ectopic, suppressed is due to adenoma
How do we typical test the effects of ACTH as related to cushings?
Optic chiasm can be impinged and produce disturbed vision
If we have a pituitary adenoma and it gets big enough what can its mass effect impinge upon and thus cause?
Hypotension, darkening of skin, muscle weakness and GI symptoms
What are some features of hypocortisolism?
ACTH is part of a large precursor that also stimulates melanocytes, so when cortisol is low extra of this will be produced
How is ACTH related to skin pigmentation? How does hypocortisolism therefore produce strange pigmentation?
Autoimmune destruction (addisons), genetic enzyme issues or metabolic defects, TB or fungal infection
What is the most common cause of adrenocortical insufficiency? THree other uncommon causes?
Cortisol to replace lose of glucs and also fludrocortisone to replace aldosterone to maintain salt levels
What are the dual therapies for adrenocortical insufficiency and why?
Knuckles, knees, gums and oral mucosa, vitiligo is dual damage to melanocytes leading to hypopig with hyperpig as well
What are the common location of addisonian pigmentation? A rare occurence and what it is?
Preamture pubic hair, hirsutism and acne, virilisation, growth spurt and premature epiphyseal fusion if in child
Features of excess androgens from adrenal issue?
Congenital adrenal hyperplasia, loss of enzymes involved in mineral/glucocortical synthesis so get shunting into excess androgens as well as excess ACTH causing adrenal hyperplasia
What is a genetic cause of excess androgens? What is going on here?
21-hydroxylase in 90%
What is the most common enzyme at the root of congenital adrenal hyperplasia?
Infant with ambiguous genitalia, premature pubic hair and large clit in young adults, adolescent hirsutism and acne
Three different life stages/presentations of female CAH?
Genitalia looks normal just slightly larger, can cause adrenal crisis due to lack of cortiso disrupting grwoth, premature sexual development at 2-3 years old
Why is CAH often missed in male babies? Problem with this? If it presents later what will it look like?
Cortisone and cortisol have equally strong gluc and mineral effects, prednisolone has high gluc but low mineral activity, dexamethasone has extremely high gluc activity and no mineral, fludrocortisone has high mineral activity with relatively low gluc
What are the five different steroid drugs in comparison to their relative gluc and mineral effects?
An increase in ECF K or angiotensin II, increases resorption of Na and water and increases removal of K
What can trigger aldosterone release apart from ACTH? What effects does it have?
Hypertension and weakenss from low potassium hypotension and potential arrythmias from high K
What are the two major signs of excess aldosterone? Too little?
Need mineralcorticoid activity as will die in days without, gluc much longer
How does the acute importance of mineralcorticoids compared to gluc?
Conn's syndrome, high sodium, low potassium and low renin due to understimulation of RAAS
What is mineralcorticoid excess referred to as? Three changes in minerals and one other hormonein blood?
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