ADRENAL TESTING
Ed Friedlander, M.D., Pathologist
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Welcome to Ed's Pathology Notes, placed here originally for the convenience of medical students at my school. You need to check the accuracy of any information, from any source, against other credible sources. I cannot diagnose or treat over the web, I cannot comment on the health care you have already received, and these notes cannot substitute for your own doctor's care. I am good at helping people find resources and answers. If you need me, send me an E-mail at scalpel_blade@yahoo.com Your confidentiality is completely respected. No texting or chat messages, please. Ordinary e-mails are welcome.

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I'm still doing my best to answer everybody. Sometimes I get backlogged, sometimes my E-mail crashes, and sometimes my literature search software crashes. If you've not heard from me in a week, post me again. I send my most challenging questions to the medical student pathology interest group, minus the name, but with your E-mail where you can receive a reply.

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Pathology's modern founder, Rudolf Virchow M.D., left a legacy of realism and social conscience for the discipline. I am a mainstream Christian, a man of science, and a proponent of common sense and common kindness. I am an outspoken enemy of all the make-believe and bunk that interfere with peoples' health, reasonable freedom, and happiness. I talk and write straight, and without apology.

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Special thanks to my friend and colleague, Charles Wheeler M.D., pathologist and former Kansas City mayor. Thanks also to the real Patch Adams M.D., who wrote me encouragement when we were both beginning our unusual medical careers.

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Especially if you're looking for information on a disease with a name that you know, here are a couple of great places for you to go right now and use Medline, which will allow you to find every relevant current scientific publication. You owe it to yourself to learn to use this invaluable internet resource. Not only will you find some information immediately, but you'll have references to journal articles that you can obtain by interlibrary loan, plus the names of the world's foremost experts and their institutions.

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KCUMB Students
"Big Robbins" -- Endocrine
Lectures follow Textbook

INTRODUCTION

ADRENAL CORTICAL DISEASES

PLASMA ACTH BY RADIOIMMUNOASSAY (normal 60 pg/mL at 9 AM)

PLASMA CORTISOL BY RADIOIMMUNOASSAY

Plasma cortisol is generally increased in Cushing's syndrome, and loss of diurnal variation (* 4 PM cortisol more than half 8 AM value) suggests Cushingism.

If your patient's "spot" cortisol at 6-8 AM is less than 80 nonamoles/L, it's either addisonism or binding protein deficiency. However, a "spot" plasma cortisol may be normal in all but the worst cases of adrenal insufficiency (addisonism). Therefore, it should not be used alone as a screening test for adrenal insufficiency!

URINARY FREE CORTISOL (normal 24-108 micrograms/24 hr)

* URINARY 17-OHCS (17-HYDROXYCORTICOSTEROIDS, PORTER-SILBER CHROMOGENS)

URINARY 17-KS (17-KETOSTEROIDS)

* URINARY 17-KGS (17-KETOGENIC STEROIDS)

ACTH STIMULATION TEST (detecting adrenal insufficiency using the lab: Ann. Int. Med. 139: 194, 2003)

METYRAPONE TEST

OTHER WAYS OF TESTING PITUITARY ACTH PRODUCTION

DEXAMETHASONE SUPPRESSION TESTS

PRIMARY ALDOSTERONISM (update Endocrinology 144: 2208, 2003).

TESTING FOR 21-HYDROXYLASE DEFICIENCY ("congenital adrenal hyperplasia")

ADRENAL MEDULLARY TUMORS

Carcinoid tumors at many sites may be detected and monitored by measuring 5-hydroxyindoleacetic acid (5-HIAA), the principal metabolite of serotonin. (Review: Endo. Metab. Clin. N.A. 17(2).

ADRENAL INCIDENTALOMAS: If you find a benign-looking adrenal nodule on CT scan, and it is >3 cm across, you should perhaps at least follow it with endocrine tests and repeat scans. ("And a chance to cut is a chance to cure": Am. Surg. 55: 516, 1989.)

(Clinical Pathology students: Learn the concepts, don't memorize the numbers.)

BIBLIOGRAPHY / FURTHER READING

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Teaching Pathology

Pathological Chess


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