True; AD, AR, polygenic Also more prevalent in females
Primary ovarian failure can be seen in APS_____
2
Most common endocrine disease seen in APS 2 is:
Grave’s disease (80-90% of females with APS 2)
Addison’s disease (in 50% of APS)
Autoantibodies for Type 1 diabetes:
GAD-65 glutamic acid decarboxylase is the primary antigen
Autoantibodies anti-islet cell
Anti-insulin
Antibody against pernicious anemia:
Autoantibody against intrinsic factor
Autoantibody against parietal cells of gastric mucosa
antigen for addisons disease:
21-hydroxylase
Antigen for vitiligo:
Melanocyte
T/F: if ACTH is not there, aldosterone, androgen and cortisol will all be affected because they’re made in the adrenal cortex
False; while it is true that they are all made in the adrenal cortex, Aldosterone is not 100% dependent on ACTH in order to be produced, it has RAAS as a backup. Cortisol and androgen production will be gone if no ACTH
Addisons disease results in hypofunction of which hormones?
Aldosterone
Cortisol
Androgen
T/F: Cushings syndrome is increased in cortisol and aldosterone
False; it is just an increased in cortisol
When adrenal insufficiency is suspected, first thing to do is:
Find out ACTH concentration to determine if its primary or secondary/tertiary
T/F: ketonconazole use could cause primary adrenal insufficiency
True; it can stop steroid synthesis.
Addison is ____ adrenal insufficiency, therefore it would have ____ ACTH, and _____ MSH
Primary
High ACTH
High MSH- so dark skin
A 49 year old female comes in to the clinic demanding a bowl of salty soy sauce ramen as dark as the color of her skin despite not having an appetite, she just wants salt. She said she has been losing weight, and feels weak with abdominal pain. You check her ACTH level, and you would expect it to be _______, in addition, you would want to look for this antibody___.
ACTH should be high, as would her MSH because these are symptoms of Addisons: salt craving, weight loss, hyperpigmentation, abdominal pain.
Antibody for 21 hydroxylase
In addisons, blood pressure would _____
Be preserved, because aldosterone is not effected
Electrolyte changes in Addison?
Hyponatremia
Hyperkalemia
Hypoglycemia
Low voltage EKG
What is Adrenoleukodystrophy?
Defective beta oxidation of very long chain fatty acids leading to accumulation in peroxisomes
T/F: Adrenoleukodystrophy is only seen in boys, as there is mutation in ABCD1 on the X chromosome
True
Progressive demyelination and Addisons is ____
Adrenoleukodystrophy
Cushings syndrome has ____ cortisol. Symptoms include:
Excessive
Stretch marks
Central adiposity
Fluid overload
Weakness, easy bruising, mood swing
Cushings would have ____ blood pressure
Increased
In Cushings, you want to do _____ (suppressive/stimulating) testing.
Suppressive (Because cushing is excess cortisol)
Dexamethasone test: suppressed in cushings disease, not suppressed in adrenal tumor
PCOS and pubarche has excess ____
Testosterone
When youre sick, expect GH, TSH, GnRH _____
To shut down
T/F: When body Is dealing with illness, thyroid is changed to inactive rT3 form
True
Adrenal crisis key features:
Shock (not responsive to fluids or pressors)
Hyponatremia, hyperkalemia, metabolic acidosis
Salt craving
Hyperpigmentation
T/F: during illness, cortisol secretion increases
True; illness is a stressor
What is relative adrenal insufficiency?
Despite a maximally ACTH activated adrenal cortex in response to critical illness, the cortisol production is still insufficient to generate enough glucocorticoid and mineralocorticoid receptor activation to maintain hemodynamic stability
When body is under stress, blood sugar ____, insulin sensitivity a____