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Clinical Chemistry
Endocrine-Adrenal Cortex
15
Chemistry
Post-Graduate
01/31/2011

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Cards

Term

[Cortisol]trough

[Cortisol]peak

 

Definition

midnight

~8:00am

--> ~ [Cortisol binding globulin]

Term

elevated [cortisol]serum

with loss of diurnal variation

DDx

Definition

Cushing syndrome

False +: stress, depression, chronic alcoholism

 

Term
Which test reflects the amount of free cortisol and is independent of diurnal variation of [cortisol]serum?
Definition

[Free cortisol]urine /24hrs

--> invalid in renal insufficiency

--> if - => cannot r/o Cushing

Term

Effect of Dexamethasone

in a Pt with normal endocrine function

Definition

suppression --> CRF, ACTH & cortisol

--> no crossreaction with cortisol assays

Term

Hypercortisolism

High-dose DST

Pt-1.Results: suppresion => Dx

Pt-2.Results: no suppression => DDx

Definition

1.Pituitary adenoma --> Cushing disease

2. ectopic ACTH / 10 adrenal hypercortisolism

Term

Metyrapone stimulation test

Results: no increase in[Cortisol]serum

Definition

Impaired pituitary ACTH production

Metyrapone--> - cortisol <-- 11,deoxycortisol

=> + ACTHpituitary

Term

The best screening test for Cushing syndrome

100% specificity

~90% sensitivity

Definition

Late-night (1:00pm) salivary cortisol

--> free cortisol that crosses into the saliva

-->independent of salivary flow rates

-->stable up to 1 week

Term

Pituitary microadenoma of basophilic cells

B/L adrenal hyperplasia

elevated [ACTH] and [Cortisol]

DX

Definition

Cushing disease

~70% of hypercortisolism cases

Term

Actopic ACTH production

Most common association

Definition
Small cell carcinoma of the Lung
Term

10 adrenal hypercortisolism

Causes

Definition

B/L adrenal hyperplasia, Adenomas1 ,Carcinomas2

Adults1=2 , children2>1

Term

Cortosyn stimulation test

 1.Pt- no response

2. Pt- good response, low [ACTH]serum

Definition

1.10 adrenal insufficiency (Addison disease)

2. 20 adrenal insufficiency

Cortosyn = ACTH analog

Term

Pt with altered mental status, weakness, hypotension, hypoglycemia, hyponatremia, hyperkalemia w metabolic acidosis & Diffuse hyperpigmentation of the skin

Dx

Definition

Addison disease (10 adrenal insufficiency)

--> co-hypersecretion of MSH

Term

Conn syndrome

Causes

Definition

hyperaldosteronism, 10 - Adrenal adenoma

20 - Renal artery stenosis, juxtaglomerular cell tm --> renin -->+ Productionaldosteron

Term
Most common cause of congenital adrenal hyperplasia
Definition

Enzyme deficiencies--> autosomal recessive

1. 21-hydroxylase--> gene conversion

2. 11-hydroxylase

Term

[17-hydroxyprogesterone] = > 242nmol/L (high)

in a randomly timed blood sample

Dx

Definition
21-hydroxylase deficiency
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