OnlineMedEd: Endocrine - "Adrenals"

Question 1

List the two sites that ACTH-producing tumors can arise.

Answer 1

• Lung (SCC)

* Pituitary

Question 2

Describe the presentation of Cushing’s.

Answer 2

Cushing’s causes things that are common in other diseases and things that are specific to Cushing’s.

Common:

• HTN
• DM
• Obesity

Specific:

• Striae
• Acne
• Buffalo hump
• Moon facies

Question 3

Review the diagnostic workup of Cushing’s syndrome.

Answer 3

Remember, LOW THEN HIGH:
•First, LOW-dose dexamethasone-suppression test (see if dexamethasone suppresses the cortisol.
• Second, THEN test the ACTH. If it is low, then you know it is a primary adrenal tumor.
•Third, if ACTH is high, then do a HIGH-dose dexamethasone-suppression test (to see if dex suppresses ACTH, which it will in Cushing’s disease but not SCC).

Question 4

In conjunction with the low-dose dexamethasone suppression test, you should do a _____________.

Answer 4

cortisol test (either midnight salivary cortisol or 24-hour urinary cortisol)

Question 5

The three most common causes of adrenal insufficiency are ____________.

Answer 5

Addison’s (autoimmune destruction), iatrogenic (too much steroids), and TB

Anterior pituitary causes are also possible though less common.

Question 6

Describe the acute and chronic presentations of adrenal insufficiency.

Answer 6

Acute:

• Hypotension
• N/V
• Coma

Chronic:

• Hyperpigmentation
• Hyponatremia
• Hyperkalemia
• Orthostatic

Question 7

Explain the diagnostic workup of suspected Addison’s.

Answer 7

• First, test AM cortisol levels. If they are low, proceed.
• Second, do a cosyntropin-stimulation test. If the cortisol does not rise, then it is likely primary adrenal insufficiency.

Question 8

What do you do with the cosyntropin stim results?

Answer 8

• If cortisol rises, then it is secondary adrenal insufficiency (i.e., broken pituitary) and you just need to replace cortisol.
• If cortisol does not rise, then it is likely primary adrenal insufficiency and you need to give cortisol and mineralocorticoids.

Question 9

_____________ is typical of hyperaldosterone states.

A vital sign and a BMP finding

Answer 9

HTN and hypokalemia

Question 10

Review the five Ps of pheochromocytoma.

Answer 10

Paroxysms of 
Palpitations, 
Pain in the head, 
Perspiration, and 
elevated blood Pressure.

Question 11

What size cutoff necessitates adrenal incidentaloma resection?

Answer 11

4 cm