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Adrenal Disroders - Coggle Diagram
Adrenal Disroders
Cushing's Syndrom
Excess Glucocorticoid exposure either autonomous ACTH secreting, ectopic ACTH secreting, or autonomous cortisiol secreting leading to increased cortisol
Causes
Exogenous
ACTH Dependent: ACTH secreting pituitary adenoma
ACTH Independent: Adrenal adenoma/Adrenal carcinoma/adrenal hyperplasia
Features
Weight gain/Fat redistribution, hypertension, impaired glucose tolerance, skin thinnin, brusining, pooor wound healing, depression, anxiety, insomnia, psychosis, imparied cognitio
Screenign
23 hr urine free cortisol, late night salivary cortisol, 1 mg dexamethansone suppresion test
Suppresion test: Normal response low serum cortisol, Low dose: Cannot suppress endogenous hypercortisol, high dose: cannot suppress ectopic ACTH
Diagnosis
Serum ACTH: low - ACTH independent, High - ACTH dependent
Treatment
Surgery (pituitary, adrenal), radiotherapy (adrenal enzyume blcokers, adrenalectomy
Congenital Adrenal Hyperplasia
Group of autosomal recessive disorders
Deficiency in enzymes of cortisol synthesis
21-OHase deficiency
Diagnosis: Elevated Serum 17-hydroxyprogesterone
Treatment: Glucocorticoid + mineralocorticoid replacemnet
Presentation
Girls: Ambiguous genitalia
Boys: Hyperkalemia, hyponatreamia, cortisol dficiency, early puberty
Long term Consequences
Issues with fertility, compromised final adult eight, hyperinsulinism, obesity, osteoporosis
Other Forms
Hypertension/Salt Retnetion
11-hydroxylase deficiency, 17-alpha hydrxylase deficiency
Death in utero
3 beta hydroxysteroid dehydrogenase deficiency
11-deoxycorticosterone: Excess leads to hypertension, hypokalemia
11OH deficiency: Treat with glucocorticoids
17-alphaOHase deficiency: Treat with glucocorticoid and sex hormones
Adrenal Insufficiencies
Primary adrenal Insufficiency
No secretion of cortisol by the adrenal gland
Causes
Autoimmune disease (addison's), infectious adrenalitis, bilateral adrenal hemorrhage, bilateral adrenal metastases
Features: Hyperpigmentation, hyperkalemia
Treat: Glucocorticoids and mineralocorticoids
Secondary Adrenal Insufficiency
No secretion of ACTH by pituitary
Causes
Pituitary tumors, surgery, truaam, apoplexy, drug induced
Features: Hypopituitarism
Treat: Only glucocorticoids
Features
Fatigue, Weakness, anorexia, weight loss, orthostatic hypotension, nausea, vomiting, diarrhea
Diagnosis
Screen: 8 am cortisol, serum ACTH, electrolyts, DHEAS (young paitents), Confirmation: 250 mcg ACTH stimulation test
Adrenal Crisis
Causes
Untreated or undertreated adrenal insufficienct + Physical Stress
Features
Nausea, vomiting, abdominal symptoms, altered level of consciousness, shock, hypotesnison, fever, hyuperpigmentation, hyperkaleia
Management
ABCs, IV access, Hydrocosticose (100 mg IV q8h)
Chronic Management
Glucocorticoid, mineralocorticoid (primary AI), sick day strategies (increase glucocorticoid dose if stressed)
Aldosterone Metabolism Disorders
Mineralocorticoid Excess
Sodium retention, potassium loss, hydrogen ion loss
Hyperaldosteronism
Primary
Causes
Aldosterone producing adenoma, adrneal hyperplasia
Leading cause of secondary hypertension, high serum sodium , hypkalemic metabolic alkalosis
Investigations
High aldosterone: Renin ratio, renin will be high in ace-inhibitors
Demonstrate non-suppresible aldosterone (captopril, saline suppresion)
Determine laterlization
Secondary
Physiologic, decreased ECV, OCP, excess urine solium loss
Hypoaldosteronism
Low aldosterone + intact cortisol production
Hyponatremia, hyperkalemia, metabolic acidosis, excess natriuresis, hypotension
Causes
Primary: adrenal issue (high renin, low aldosterone)
Adrenal enzyme deficiency, autoimmune adrenalitis (addisons), arenalectomy
Secondary: (inability to produce adequte renin, angiotensin)
CKD, Diabetes Mellitus, NSAIDs
Pseudohypoaldosteronism (resistance of target tissue action to aldosterone, high renin, high aldosteronism, hyperkalemia)
Adrenal Medulla Disorders
Pheochromocytoma
Tumor of chromaffin cells
Catecholamine excess
Clinical Features
headache, diaphoresis, palptitions, anxiety, hypertension, pallor, tachycardia
Diagnossi
24 hr metabenphrines, normetanephrines
Localization with imaging
Management:
Alpha receptor blocker, beta recpetor blocker, surgical resection, post-operative management
Adrenal Incetaloma
Imaging done for other indication
Non-secretor vs functional