Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
35 Cards in this Set
- Front
- Back
Glucose abnormalities/Diabetes
Psychological changes Hypertension Bone loss/Osteoporosis Obesity (central) Proximal muscle weakness are signs of? |
Cortisol excess (Cushing's syndrome)
also: Weight gain (80-97%) Moon facies (75%) Proximal muscle weakness/wasting (61%) Striae (reddish-purple >1 cm (66%) Plethora (60%) Compression fractures (22%) Liddle’s sign: paper-thin skin on dorsum of hand |
|
4 causes of cushing syndrome (cortisol excess)
|
Iatrogenic is most common - history of glucocorticoid use
Cushing’s Disease (pituitary tumor) Ectopic A.C.T.H. (small cell lung cancer) Adrenal Tumor |
|
describe ACTH independent cushing syndrome..cause?
|
ACTH is low or zero
comes from cortisol producing adrenal tumor |
|
possible causes of ACTH dependent cushings?
|
ACTH secreting pituitary tumor
Ectopic ACTH |
|
in ectopic ACTH causing Cushing syndrome, what can you see in up to 10% of cases?
*in red, but he didn't really say anything about it |
Can see unrelated tumors in pituitary in up to 10% of cases
|
|
again, what were the 2 tests for Cushing syndrome? levels?
|
24 hour free urine
Dexamethasone Suppression test Level <5 ug/dL rules out Cushing’s Level >10 ug/dL is highly suggestive |
|
Dexamethasone levels showing cushings?
|
Level <5 ug/dL rules out Cushing’s
Level >10 ug/dL is highly suggestive |
|
Once Cushing’s is established, the next step is to determine whether it is ACTH-Dependent or ACTH-Independent. When you measure, what levels show each?
|
<5 pg/ml in ACTH-independent
>20 pg/ml in ACTH-dependent |
|
how can you tell the difference btw pituitary secreting ACTH or ectopic?
|
pituitary can be suppressed with high dose steroids...ectopic cannot (on dexamethasone suppression test)
|
|
when you do surgery for ectopic ACTH producing tumors what must you do first?
|
Remember to start replacement before surgery.
because their values will be off |
|
26 year old woman comes to your office for complaints of weight gain, plethora, Buffalo hump, proximal muscle weakness and amenorrhea. You note hypertension, hyperglycemia and hirsuitism. Which of the following studies would be most appropriate to order at this time?
A. MRI of the brain with special attention to the pituitary B. Morning and afternoon cortisol levels C. 24-hour urinary free cortisol D. Morning cortisol and ACTH level |
C. 24-hour urinary free cortisol
(other option would have been low dose dexamethasone suppression test) |
|
What are some of the clinical manifestations of adrenal insufficiency?
|
Fatigue and weakness (95%)
Anorexia (90%) Weight loss (100%) Impaired mentation (75%) |
|
most common infectious cause of adrenal insufficiency?
|
TB
(others: fungal, HIV) |
|
What is Addison's Disease?
|
Autoimmune Adrenal Insufficiency (80% of all primary adrenal insufficiency).
Can be associated with Polyendocrine Autoimmune Syndrome. Type 1 includes mucocutaneous candidiasis, hypoparathyroidism, gonadal failure, pernicious anemia, Hashimoto;s thyroiditis, autosomal recessive or sporatic. Type 2 include Type 1 DM, Hashimoto’s, Grave’s, gonadal failure, autosomal dominant. |
|
Salt craving
Hyperpigmetation Hyperkalemia are findings of what? |
Addison's disease
|
|
what is mineralocorticoid function like in secondary adrenal insufficiency?
|
Mineralocorticoid function is intact
do not see associated hyperkalemia |
|
If only primary adrenal insufficiency is suspected, do ACTH, what should the levels be?
|
> 100 pg/mL.
|
|
what is the Cosyntropin (ACTH) Stimulation Test?
|
250 ug injected IM or IV
Cortisol levels are measured at 0, 30 and 60 minutes. Normal response is a rise in cortisol to > 20 ug/dl. if it doesn't go above 20 then you have adrenal insufficiency Sensitivity 97% for primary adrenal insufficiency. 57% for secondary adrenal insufficiency. |
|
tx for adrenal insufficiency (primary)
|
Glucocorticoid replacement
Hydrocortisone or Prednisone Mineralocorticoid replacement (primary only) Fludrocortisone (Florinef) |
|
24 year old man presents with fatigue, weight loss and dizziness. His glucoses are normal/low. Sodium low and potassium slightly high. You suspect adrenal insufficiency. Which test would be most appropriate?
A. AM cortisol and ACTH B. Cosyntropin (ACTH) stimulation test C. 24-hour urinary cortisol |
B. Cosyntropin (ACTH) stimulation test
|
|
if you have an adrenal incidentaloma, at what size do you consider surgery? What MUST you rule out before surgery?
***red |
if > 4 cm consider removal
ALWAYS RULE OUT PHEOCHROMOCYTOMA BEFORE SURGERY |
|
66 year old woman is hospitalized for abdominal pain. A C.T. scan reveals a 3 cm solid mass in the right adrenal gland. She is obese and has diabetes and hypertension. What do you recommend?
A. Consult a surgeon to remove the mass. B. Obtain appropriate studies to asses function C. Repeat CT at a later date |
B. Obtain appropriate studies to asses function
(this is the initial thing to do, you would want to repeat the CT later) |
|
clinical manifestations of hyperaldosteronism?
|
Hypertension
Hypokalemia |
|
cause of primary hyperaldosteronism? Renin levels?
|
Caused by adrenal adenoma or bilateral adrenal hyperplasia
High aldosterone despite fluids and sodium Low plasma renin activity despite fluid depletion or postural changes. |
|
aldosterone:renin of 20:1 is most likely?
|
primary hyperaldosteronism
|
|
renin levels in secondary hyperaldosteronism?
|
High
|
|
Episodes of headache, tachycardia, diaphoresis, anxiety, or chest pain/pressure
Hypertension (higher with episodes) “Spells” associated with? |
Pheochromocytoma
|
|
best diagnostic test for Pheochromocytoma?
|
24 hour metanephrines, catecholamines and/or VMA
|
|
best way to image a pheochromocytoma?
|
MRI
|
|
what is the rule of 10s? associated with?
|
associated with pheochromocytoma
10% in kids 10% bilateral extra-adrenal maligant calcify familia |
|
what are the 5 Ps of pheochromocytoma?
|
pressure (increased BP)
pain (headache) perspiration palpitations (tachy) pallor |
|
prior to surgery, what must a pheochromocytoma pt be pre-treated with?
***red |
The patient must be pretreated with Alpha blocker prior to surgery. Phenoxybenzamine is most commonly used.
|
|
A patient presents with “spells” characterized
by tachycardia, chest tightness and episodic severe headaches. Blood pressure has been high and difficult to control. What test(s) would you order? C.T. or MRI of adrenals? 24hour urine for metanephrines? Plasma catecholamines? |
24hour urine for metanephrines
|
|
DHEA is the principle androgen secreted by the adrenal gland... what levels suggest adrenal tumor?
|
DHEA-S >700 suggests adrenal tumor
|
|
Testosterone is the principle androgen from the gonads. levels of what suggest an ovarian tumor?
|
>200 in females suggest ovarian tumor
|