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COMAT - IM > End Part 2 > Flashcards

End Part 2 Flashcards

1
Q

Difference between Cushing Syndrome and Disease?

A

Syndrome = Excess Cortisol
Disease = ACTH producing tumor

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2
Q

Cushing Syndrome is often caused by exogenous steroids. List some physical exam findings

A

Central obesity with striae
Moon facies
Buffalo hump
Bruising/purpura
Muscle weakness
Thin skin

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3
Q

If you suspect high cortisol levels, what should be done first?

A

24 hour urine cortisol levels

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4
Q

If 24 hour cortisol is elevated, then what?

A

Low-dose Dexamethasone suppression test

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5
Q

What will be the result of a Low-dose Dexamethasone suppression test with Cushing Syndrome?

A

FAILS to suppress cortisol

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6
Q

Once the cortisol fails to suppress with a low-dose dexamethasone test, what should be done next?

A

Measure ACTH – Is the high cortisol ACTH independent or dependent?

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7
Q

If ACTH is low with high Cortisol, where is the likely source?

A

Adrenals – get a CT/MRI

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8
Q

If ACTH is high with high Cortisol, what should be done?

A

High-dose dexamethasone suppression test

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9
Q

If the High-dose dexamethasone suppression test suppresses cortisol, what is the diagnosis?

A

Pituitary adenoma

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10
Q

If the High-dose dexamethasone suppression test does NOT suppress cortisol, what is the diagnosis?

A

Ectopic ACTH producing tumor

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11
Q

List as many Cushing syndrome signs as possible

A

Abdominal obesity with striae
Moon facies
Buffalo hump
Bruising/purpura
Muscle weakness
Thin skin

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12
Q

If you suspect a GH secreting tumor, what should be measured?

A

IGF-1

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13
Q

If IGF-1 is HIGH, what should be done next?

A

Glucose suppression test

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14
Q

GH secreting tumors present as Gigantism in children and Acromegaly in adults. What is the treatment options?

A

Surgery
Somatostatin analogs to (-) GH secretion

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15
Q

Medical treatment for GH tumors?

A

Somatostatin analogs to (-) GH secretion
ex. Octreotide

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16
Q

What are 2 complications of Acromegaly?

A

Diabetes
Cardiomyopathy

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17
Q

What are the levels of the Adrenal Cortex and what do they secrete?

A

GFR
- Glomerulosa –> Aldosterone
- Fasciculata –> Cortisol
- Reticularis –> Androgens

18
Q

What regulates the levels of the Adrenal Cortex?

A

Glomerulosa – Angiotensin 2
Fasciculata and Reticularis – ACTH

19
Q

What is in the Adrenal Medulla?

A

Chromaffin cells that produce catecholamines Epinephrine and Norepinephrine

20
Q

What is Adrenal Insufficiency?

A

Inadequate production of Glucocorticoids +/- Mineralocorticoids

21
Q

Common causes of Primary Adrenal Insufficiency?

A

Autoimmune (Addison’s)
TB
Hemorrhage (Waterhouse-Friderichsen)

22
Q

Describe the lab values with Primary Adrenal Insufficiency

A
  • Low Aldosterone –> High K+
  • Low cortisol
  • High ACTH
23
Q

What are the signs of Primary Adrenal Insufficiency?

A

Fatigue, anorexia, weight loss and skin hyperpigmentation

24
Q

What causes the skin hyperpigmentation with Primary Adrenal Insufficiency?

A

High ACTH

25
Q

If you suspect Primary Adrenal Insufficiency, what test should be done?

A

Cosyntropin ACTH stimulation test

26
Q

What will be the result of Cosyntropin ACTH stimulation test with Primary Adrenal Insufficiency?

A

NO RISE in Cortisol

27
Q

What is the treatment for Primary Adrenal Insufficiency?

A

Replace glucocortiocoids +/- mineralocorticoids (fludracortisone)

28
Q

Secondary/Tertiary Adrenal Insufficiency is due to?

A

LOW ACTH

29
Q

What will the lab values be with Secondary/Tertiary Adrenal Insufficiency?

A

LOW ACTH
- Low cortisol
- Aldosterone, Na and K UNAFFECTED because they are regulated by Angiotensin 2

30
Q

An Acute Adrenal Crisis is due to abruptly stopping long-term steroids. How may that present?

A

Confusion
Hypotension
Coma

31
Q

What is the treatment for an Acute Adrenal Crisis? (2)

A

Volume resuscitation + STEROIDS

32
Q

Congenital Adrenal Hyperplasia is due to enzyme deficiencies. What is the most common?

A

21-hydroxylase

33
Q

In general, what is present with 21-hydroxylase deficiency?

A

LOW mineralocorticoids and glucocorticoids
HIGH Androgens

34
Q

How will 21-hydroxylase deficiency present?

A

Ambiguous genitalia and hypotension

35
Q

What marker is specific for adrenals?

A

DHEA-S

36
Q

Besides androgens, what will be elevated with 21-hydroxylase deficiency?

A

17-OHP and Renin!

37
Q

If 11beta-hydroxylase deficiency is to blame for CAH, how does that differ from 21-hydroxylase?

A

NO LOW BP – 11-deoxycorticosterone is produced and is able to raise the BP

38
Q

MEN 1

A

Pituitary
Parathyroid
Pancreas

39
Q

MEN 2A

A

Parathyroid
Pheochromocytoma
Medullary thyroid carcinoma

40
Q

MEN 2B

A

Pheochromocytoma
Medullary thyroid carcinoma
Marfanoid habitus

COMAT - IM (17 decks)

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