Addison's dz Q

[mountaindew2006]

hey guys-

real quick. I was doing a qbank q...it essentially said that woman presentd with hyperpigmented skin. profound fatigue and weakness and diarrhea and constipation. Tumor involvemnt of which endocrine organ is implicated.

The answer was adrenal gland ---- addison's dz. I know that the hyper pigmentation can be seen in add's dz because of the increase in ACTH. However, couldnt one get hyperpigmentation as a result of Cushing's Disease (where there's an increase in ACTH due to a primary pituitary adenoma) ? That's the reason I chose the gland to be 'pituitary'. any thoughts ?

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[Idiopathic]

You can, theoretically, but you have to play averages...i dont see any Cushingoid signs here, but the weakness and GI signs lead me to a hypothyroid or hypocortisol condition. Odds are it is Addisons.

 

[Kalel]

hyperpigmentation is one of the manifestations of cushing disease, but the other effects of hypercortisolism should also be present as well (striae, acne, bruising, weight gain, supraclavicular fat pads, moon facies, etc). Your patient's other vague sx may be consistent with Cushing's disease, but I think that she would have other signs and sx that would be more prominent.

 

[GiJoe]

Originally posted by mountaindew2006
hey guys-

real quick. I was doing a qbank q...it essentially said that woman presentd with hyperpigmented skin. profound fatigue and weakness and diarrhea and constipation. Tumor involvemnt of which endocrine organ is implicated.

The answer was adrenal gland ---- addison's dz. I know that the hyper pigmentation can be seen in add's dz because of the increase in ACTH. However, couldnt one get hyperpigmentation as a result of Cushing's Disease (where there's an increase in ACTH due to a primary pituitary adenoma) ? That's the reason I chose the gland to be 'pituitary'. any thoughts ?

A tumor on the adrenal gland (usually and adenoma) would not cause hyperpigmentation. Hyperpigmentation is caused an ACTH secreting tumor of pituitary origin because ACTH and MSH share the same prohormone. An adrenal tumor would cause a decrease in ACTH release from the pituitary via negative feedback and thus a decrease in MSH... therefore you wouldnt see any hyperpigmentation.

 

[Idiopathic]

I think what they are describing here is an adrenal metastasis, which could destroy adrenal function and cause Addisons. An adrenal adenoma could hyper-function, which would give you ACTH-suppressed Cushing's, yes. However, the adrenals are frequently metastasized to, especially by the lungs.

And dont forget about Waterhouse-Friedrichson syndrome...bilateral adrenal hemorrhage/infarct following meningococcemia. Kids who are getting better suddenly get hypotensive.

 

[csmith1]

TB, as well!

 

[Idiopathic]

Ah yes...I read about testicular TB the other day. That bug blows me away.

 

[Kalel]

Originally posted by GiJoe
A tumor on the adrenal gland (usually and adenoma) would not cause hyperpigmentation. Hyperpigmentation is caused an ACTH secreting tumor of pituitary origin because ACTH and MSH share the same prohormone. An adrenal tumor would cause a decrease in ACTH release from the pituitary via negative feedback and thus a decrease in MSH... therefore you wouldnt see any hyperpigmentation.

Technically, cushing disease=hyper-ACTH leading to hyper-cortisolism. cushing syndrome=hyper-cortisolism, with or without hyper ACTH. The most common cause of cushing syndrome in this country is actually iatrogenic, from exogenous corticosteroid ingestion.

 

[mountaindew2006]

thanks guys...

yes, i just confired with the beast...robbins.....

indeed you do get hyperpigmentation with addisons dz. But also supposedly those GI sx's are assoc w/ addisons and not cushings. In terms of hyperpigmentation in cushing's dz (inc in acth) I dont see how you wouldnt get hyperpigmentation as well since i'm assuming the ACTH precursor is the same in both cases (giving rise to MSH) . At any rate I suppose Qbank is right given the GI sx's.

THANKS for the help !! SDN ROCKS!!

 

[Mossjoh]

Originally posted by GiJoe
A tumor on the adrenal gland (usually and adenoma) would not cause hyperpigmentation. Hyperpigmentation is caused an ACTH secreting tumor of pituitary origin because ACTH and MSH share the same prohormone. An adrenal tumor would cause a decrease in ACTH release from the pituitary via negative feedback and thus a decrease in MSH... therefore you wouldnt see any hyperpigmentation.

Hold on..not necessarily. Metastatic tumors to the adrenals can cause adrenal destruction, which also classifies as Addison's Disease I believe. In that case...ACTH would be elevated because of loss of negative feedback, resulting in hyperpigmentation. However, adrenal crisis is not very compatible with life....

Mossjoh

 

[Mossjoh]

You can get hyperpigmentation in Cushing's Syndrome if it CUSHING'S DISEASE....causes by a pituitary adenoma that secretes ACTH...or also a tumor elsewhere with a paraneoplastic secretion of ACTH.

Mossjoh

 

[Idiopathic]

Yes, you can get hyperpigmentation with both Cushing's disease (which involves primary pituitary oversecretion of ACTH) or Addison's disease (which involves adrenal cortex failure, causing reflex overproduction of ACTH). It is more notable in Addison's, especially when other signs are present.

The tumor is most likely metastasis to the adrenals, which is VERY common, or it could be destruction from a non-functioning adenoma.

 

[southerndoc]

You can, theoretically, but you have to play averages...i dont see any Cushingoid signs here, but the weakness and GI signs lead me to a hypothyroid or hypocortisol condition. Odds are it is Addisons.

Idio is right on here...

Remember, a lot of questions will have very similar answers (as you've probably noticed from qBank). Go with your gut instinct. If it sounds like Addison's (and the case you presented does sound like Addison's), then go for it. Don't talk yourself out of it!

By the way, I found qBank to be harder than Step I. Some people said otherwise, but I thought Step I was easier than qBank.