Endocrinology Quiz on Adrenal Disorders

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Questions and Answers

What is the primary dysfunction location in Cushing's disease?

Peripheral tissues

Adrenal glands

Pituitary gland (correct)

Hypothalamus

Which of the following clinical features is most commonly associated with Addison's disease?

Excessive thirst

Hyperglycemia

Hyperpigmentation (correct)

Hypertension

Which diagnostic test is most relevant for diagnosing Conn's disease?

Aldosterone: renin ratio (correct)

Insulin tolerance test

17-OH progesterone

Cortisol testing

What is a common complication associated with pheochromocytoma?

Cardiovascular disease Signup and view all the answers

In adrenal neoplasms, which feature is typically correlated with poor prognosis?

Presence of necrosis Signup and view all the answers

What is the primary consequence of complete inactivation of 21-hydroxylase in salt-wasting congenital adrenal hyperplasia?

Dehydration and hypotension Signup and view all the answers

What condition can late-onset non-classic congenital adrenal hyperplasia in women mimic?

Polycystic ovary syndrome (PCOS) Signup and view all the answers

What is a common characteristic of female infants with simple virilizing congenital adrenal hyperplasia?

Ambiguous genitalia at birth Signup and view all the answers

In patients diagnosed with pheochromocytoma, what is the typical secretion observed?

High quantities of catecholamines Signup and view all the answers

What lab finding is expected in a patient with non-classic congenital adrenal hyperplasia?

High levels of 17-hydroxyprogesterone Signup and view all the answers

What result indicates primary adrenal insufficiency during an ACTH stimulation test?

Low cortisol and high ACTH Signup and view all the answers

What is a characteristic feature of primary hyperaldosteronism?

Hypertension and hypokalemia Signup and view all the answers

Which condition is a possible cause of secondary hyperaldosteronism?

Cirrhosis Signup and view all the answers

How is congenital adrenal hyperplasia (CAH) primarily inherited?

Autosomal recessive Signup and view all the answers

In primary hyperaldosteronism, what would you expect the aldosterone to renin ratio (ARR) to be?

Large (high aldosterone: low renin) Signup and view all the answers

What is the most common enzyme deficiency in congenital adrenal hyperplasia?

21-Hydroxylase Signup and view all the answers

What is a key clinical manifestation of hypokalemia associated with hyperaldosteronism?

Skeletal muscle weakness Signup and view all the answers

Which factor is NOT associated with primary hyperaldosteronism?

Renal artery stenosis Signup and view all the answers

What is the expected appearance of adrenal tissue when an adenoma is found in only one adrenal gland?

It appears smaller due to atrophy. Signup and view all the answers

Which scenario describes the mechanism of Cushing's disease?

High ACTH levels from a pituitary tumor leading to high cortisol. Signup and view all the answers

How can serum ACTH levels help differentiate between primary Cushing's disease and ACTH-dependent forms?

High ACTH with low cortisol indicates ACTH dependence. Signup and view all the answers

What characterizes adrenal insufficiency as acute or chronic?

Chronic insufficiency may present like acute if stressed. Signup and view all the answers

Why might sudden withdrawal from high doses of glucocorticoids lead to adrenal insufficiency?

The body may not have enough time to adjust steroid production. Signup and view all the answers

What is a distinguishing factor between primary and secondary adrenal insufficiency?

Primary insufficiency involves adrenal glands, while secondary involves other glands. Signup and view all the answers

What role does cortisol play in feedback mechanisms within the endocrine system?

It has a negative feedback effect on ACTH production. Signup and view all the answers

In Cushing's syndrome, what does a high-dose dexamethasone suppression test typically show?

Cortisol remains high with no suppression. Signup and view all the answers

What is the primary cause of primary acute adrenocortical insufficiency?

Decreased ACTH stimulation Signup and view all the answers

Which of the following is NOT a clinical feature of acute adrenal insufficiency?

Visual disturbances Signup and view all the answers

What is the most common cause of Addison's disease in developed countries?

Autoimmune destruction of the adrenal cortex Signup and view all the answers

Which of the following conditions is associated with secondary adrenocortical insufficiency?

Hypopituitarism Signup and view all the answers

Which laboratory test would help determine if there is an ACTH deficiency?

Insulin tolerance test Signup and view all the answers

What is a common consequence of stress on individuals with chronic adrenal insufficiency?

Adrenal crisis Signup and view all the answers

Which symptom is associated with chronic primary adrenal insufficiency in Addison's disease?

Hyperpigmentation Signup and view all the answers

What happens to sodium and potassium levels in Addison's disease?

Low sodium and elevated potassium Signup and view all the answers

Which statement about acute adrenal hemorrhage is true?

It can result from anticoagulant therapy. Signup and view all the answers

Which type of autoimmune syndrome primarily affects older children and adolescents in Addison's disease pathogenesis?

APS type 1 Signup and view all the answers

Study Notes

Adrenal Pathologies Overview

Cushing's syndrome characterized by excess cortisol; Cushing's disease is specifically due to a pituitary tumor causing excess ACTH.
Addison's disease indicates a deficiency in adrenal hormones, often due to autoimmune destruction of the adrenal cortex.
Conn's disease results from hyperaldosteronism, leading to hypertension and hypokalemia due to excessive aldosterone production.

Cushing's Syndrome and Disease

Cushing's syndrome presents with high cortisol, elevated ACTH in pituitary tumors, and low cortisol after dexamethasone suppression.
Dexamethasone suppression test differentiates between various forms of Cushing’s.
Ectopic ACTH production (from tumors like lung cancer) leads to high ACTH and cortisol levels; pituitary tumors show high ACTH coupled with high cortisol.

Addison's Disease and Adrenal Insufficiency

Chronic adrenal insufficiency results from significant destruction of the adrenal cortex (90% affected).
Common etiologies include autoimmune destruction, tuberculosis, AIDS, and metastatic cancer.
Clinical features include progressive weakness, gastrointestinal symptoms, hyperpigmentation, hypotension, and acute adrenal crisis risk during stress.

Secondary Adrenal Insufficiency

Typically results from hypothalamic or pituitary disorders leading to decreased ACTH levels.
Presents with low cortisol and ACTH but normal aldosterone levels, avoiding complications like hyperkalemia.
Insulin tolerance and CRH tests assess pituitary function and cortisol responsiveness.

Primary Hyperaldosteronism

Characterized by excess aldosterone leading to sodium retention, potassium excretion, hypertension, and hypokalemia.
Etiologies include adrenal neoplasms (Conn's syndrome) and bilateral adrenal hyperplasia.
Aldosterone: renin ratios help distinguish between primary and secondary causes of hyperaldosteronism.

Congenital Adrenal Hyperplasia (CAH)

Autosomal recessive disorder primarily due to 21-hydroxylase deficiency; leads to reduced cortisol and resulting adrenal hyperplasia.
Classic forms include salt-wasting (complete 21-hydroxylase inactivation) and simple virilizing forms (partial function).
Non-classic CAH manifests later in life, often resembling polycystic ovary syndrome in women.

Pheochromocytoma

Rare tumor of adrenal chromaffin cells, predominantly secretes catecholamines (epinephrine/norepinephrine).
Most cases are sporadic, but some arise in hereditary contexts, causing persistent hypertension and episodic symptoms like headaches and palpitations.

Diagnostic Tests

Key tests include insulin tolerance, CRH stimulation, ACTH levels, cortisol testing, DXM suppression, and aldosterone:renin ratio.
High 17-OH progesterone levels indicate CAH; elevated plasma renin suggests secondary hyperaldosteronism.

Complications

Addisonian crisis can lead to severe hemodynamic instability, hypoglycemia, and potentially fatal outcomes without immediate treatment.
Chronic adrenal insufficiency may remain asymptomatic until an acute stressor demands increased adrenal function.

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Description

Test your knowledge on adrenal disorders with this quiz that explores Cushing's disease, Addison's disease, Conn's disease, and pheochromocytoma. Evaluate your understanding of the clinical features, diagnostic tests, and prognostic factors associated with these conditions. Perfect for students and professionals in the field of endocrinology.