1DDX: LECTURE 47 – APRIL 13TH, 2007

Endocrine (3), Adrenal Cortex

(No page numbers: we didn’t get this note package until the next class)

THYROID:
Women outstrip men in benign conditions of the thyroid, but men outstrip women in malignant conditions.
Specific conditions of the thyroid that affect elderly (>50): Toxic multinodular goiter.
20-30 years old, tends to be more autoimmune conditions.
Graves is associated with pernicious anemia, rheumatoid arthritis.
Find a cold nodule? Red flag for cancer.

ADRENAL:
Patient may present with diffuse pigmentation on flexor surfaces, around scars, areola, mucus membranes.
DDX: systemic sclerosis due to thickening of the skin.
Buccal fat pad enlargement: cushings
Cushings: thinning of skin, bruises easily.

Lab tests? Serum ACTH and Serum cortisol are most useful.

Serum ACTH:
Decreased: steroids suppress adrenals. Estrogen, alcohol, insulin: may elevate ACTH.

Serum cortisol:
Lowest at 12pm.
First sign of loss of diurnal variation: assess via salivary cortisol.

Urinary 17-OCHS: useful for alcoholic cirrhosis.

Liquorice increases 17-OCHS

In severe stress, adrenals produce less androgens and more cortisol.

Aldosterone: level greatly increases in upright position.

Congenital adrenal hyperplasia:

1. Simple virilizing CAH
2. Salt-wasting: losing all your salt.

Addison’s
Hyperpigmentation (primary) ex. JFK
Electrolyte tests are off in primary. In secondary Addison’s they are normal.

DDX LECTURE 47, APRIL 13TH, 2007 – PAGE 1