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Adrenal Insufficiency - Differential Diagnosis Workup Algorithm Primary Adrenal Insufficiency: • Autoimmune primary adrenal insufficiency • Adrenoleukodystrophy,
Adrenal Insufficiency ... Algorithm Primary Adrenal ... Autoimmune primary adrenal ... ACTH-deficiency • Combined pituitary ... Insufficiency #Adrenal
The principal endocrine 'axes' and glands. Parathyroid glands, adrenal zona glomerulosa and endocrine pancreas are not
Parathyroid glands, adrenal ... controlled by the pituitary ... Pathways #Diagnosis #Pituitary
Hypercortisolism (Cushing syndrome) - Simplified Differential Diagnosis Algorithm Exogenous (ACTH-independent) Endogenous • ACTH-dependent: - ACTH-secreting
ACTH-secreting pituitary ... ACTH-independent: - Adrenal ... hyperplasia - Adrenal
Primary vs Secondary Adrenal Insufficiency - Pathophysiology Primary AI = adrenal glands themselves are the problem. This
Primary vs Secondary Adrenal ... Pathophysiology Primary AI = adrenal ... Secondary AI = the pituitary ... leads to limited adrenal ... Primary #Secondary #Adrenal
Causes of Adrenal Insufficiency - Differential Diagnosis Algorithm ACTH-Dependent (Secondary): • Pituitary Dysfunction • Hypothalamic Dysfunction ACTH-Independent (Primary):
Causes of Adrenal ... Secondary): • Pituitary ... Thrombophilia (adrenal ... Medicine @SCVMCMed #Adrenal
Causes of Adrenal Insufficiency - Differential Diagnosis Algorithm Autoimmune: • Isolated • Polyglandular autoimmune syndrome 1 •
Causes of Adrenal ... - Central: • Pituitary ... amzn.to/2LmUODZ #Adrenal
Primary Adrenal Insufficiency: • ACTH stimulation test - Synthetic ACTH does not stimulate cortisol secretion because
Primary Adrenal ... dysfunctional adrenal ... inhibition by adrenal ... hypothalamus or pituitary ... deficiency (from the pituitary
Cushing Syndrome Testing Algorithm INDICATIONS FOR TESTING: • Suspected Cushing syndrome (central obesity, muscle weakness, refractory hypertension) Testing:
Hormone • MRI of adrenal ... glands, pituitary ... endocrinology #Adrenal
Limbic system Medial/rostral hypothalamus Lateral hypothalamus Hypothalamic neurosecretion ADH Autonomic centers Signal generator CRH Negative feedback Sympathetic nervous system Anterior pituitary ACTH Adrenal medulla Adrenal cortex #Cortisol #Epinephrine (norepinephrine) Response to signal
system Anterior pituitary ... ACTH Adrenal ... medulla Adrenal
Congenital Adrenal Hyperplasia - 21-Hydroxylase Deficiency - Signs and Symptoms • Brain: Androgenization effects, Glucocorticoid effects,
Congenital Adrenal ... • Hypothalamic–Pituitary ... resistance • Adrenal ... subfertility, Adrenal ... CAH #Congenital #Adrenal
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