17 Questions
What is the most common cause of Addison's disease?
Autoimmune destruction of the adrenal cortex
What is the first-line treatment for pituitary-dependent Cushing's syndrome?
Surgery to remove the pituitary adenoma
Which of the following is a potential complication of Addison's disease?
Addisonian crisis
What is the primary function of the adrenal medulla?
Production of catecholamines
Which of the following is a common symptom of Cushing's syndrome?
Moon face
Which of the following is a common cause of Addisonian crisis?
Severe illness
Which of the following is NOT a typical sign or symptom of Addisonian crisis?
Hypercalcemia
In managing Addisonian crisis, what is the initial recommended treatment?
IV fluids and IV/IM hydrocortisone
Which hormone is primarily responsible for the skin hyperpigmentation seen in Addisonian crisis?
ACTH
Which class of steroid hormones is NOT required for specific replacement in Addisonian crisis management?
Mineralocorticoids
Which part of the adrenal gland is affected in congenital adrenal hyperplasia (CAH)?
Adrenal cortex
What is the primary function of mineralocorticoids like aldosterone?
Maintaining and regulating electrolyte balance
What is the primary function of glucocorticoids like cortisol?
Stimulating gluconeogenesis
What is the typical clinical appearance of Cushing's Syndrome?
Rounded face and acne
What is the normal daily dosage range for adrenal cortex hormones?
10-20 mg/day
Which of the following is an adrenal cortex disorder?
Cushing's Syndrome
What is the role of the pituitary gland in Cushing's Syndrome?
It regulates the activity of the adrenal glands
Study Notes
Adrenal Gland Disorders
- Congenital adrenal hyperplasia (CAH) is a condition where the adrenal glands are not functioning properly from birth.
- Iatrogenic bilateral adrenalectomy is a condition where both adrenal glands are surgically removed due to medical treatment.
Addison's Disease
- Addison's disease is a condition where the adrenal glands do not produce enough cortisol and aldosterone hormones.
- It is a life-threatening disorder that affects people between 30-50 years old.
- Causes of Addison's disease include:
- Autoimmune disorders (70% of cases)
- Malignancy (50% of cases)
- Infiltration (e.g., amyloid, sarcoidosis)
- Infection (e.g., TB, fungal, CMV, HIV)
- Vascular causes (e.g., hemorrhage, infarction due to thrombosis)
- Congenital causes
Addisonian Crisis
- Addisonian crisis is an acute episode of Addison's disease that can be brought on by:
- Stressors
- Surgery
- Alcohol intoxication
- Hypothermia
- MI
- Severe illness
- Trauma
- Hypoglycemia
- Infection
- Signs and symptoms of Addisonian crisis include:
- Progressive weakness
- Weight loss
- Anorexia
- Skin hyperpigmentation
- Hypotension
- Hyponatremia
- Hyperkalemia
- Metabolic acidosis
- Hypercalcemia
- Hypoglycemia
- Eosinophilia and lymphocytosis
- GI disturbances (nausea, vomiting, diarrhea)
Management of Addisonian Crisis
- Management should start as soon as the condition is anticipated, rather than waiting for confirmatory results.
- Blood should be taken urgently for:
- RBS
- Electrolytes
- Cortisol and other infection screening
- Treatment includes:
- IV fluids (0.9% Normal saline) several liters within 24-48 hours
- Hydrocortisone 100 mg IV, and 100 mg IM, and then continued 6-hourly for 24-48 hours
- When patients are able to take orally, double replacement (hydrocortisone 20, 10 mg orally)
Cushing's Syndrome
- Cushing's syndrome is a condition caused by abnormally high circulating levels of corticosteroid hormones.
- Causes of Cushing's syndrome include:
- Adrenal gland tumor
- Administration of corticosteroid drugs
- Enlargement of both adrenal glands as a result of pituitary tumor
- Pituitary gland controls the activity of the adrenal gland by producing adrenocorticotropic hormone (ACTH)
- Clinical appearance of Cushing's syndrome includes:
- "Moon face" and acne
- Truncal obesity and weight gain
- Muscle atrophy and wasted limbs
- Purple stretch marks on the abdomen, thighs, and breasts
- Thinned skin that bruises easily
- Weakened bones at increased risk of fracture
- Other features of Cushing's syndrome include:
- Increased body and facial hair
- Hump on the back of the neck ("buffalo hump")
- Supraclavicular fat pads
- Hypertension and DM
Adrenal Cortex
- The adrenal cortex produces three types of hormones:
- Mineralocorticoids (e.g., aldosterone)
- Glucocorticoids (e.g., cortisol)
- Gonadocorticoids (e.g., testosterone, estrogen, progesterone)
- Cortisol regulates metabolism by:
- Stimulating gluconeogenesis
- Mobilizing free fatty acids
- Glucose sparing
- Exhibiting anti-inflammatory effects
Test your knowledge on the hormones produced by the adrenal cortex including mineralocorticoids like aldosterone, glucocorticoids such as cortisol, and gonadocorticoids. Learn about their functions in regulating electrolyte balance, metabolism, and the inflammatory response.
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