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Endocrinology > Disorders of the Adrenal Glands > Flashcards

Disorders of the Adrenal Glands Flashcards

1
Q

clinical manifestations (S&S) due to hypercortisolism (excessive glucocorticoids)

A

cushing syndrome

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2
Q

what is the most common cause of cushing syndrome?

A

exogenous steroid drugs

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3
Q

what is the most common cause of spontaneous cushing syndrome?

A

cushing disease

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4
Q

what is the 2nd most common cause of cushing syndrome?

A

adrenal tumor

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5
Q

ACTH hypersecretion by the pituitary due to very small benign pituitary adenoma

A

cushing disease

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6
Q

a patient presents with central obesity, moon face, buffalo hump, purple striae, slow wound healing, muscle weakness, depression, hypertension, DM, menstrual irregularities, and decreased libido. what are they likely experiencing?

A

Cushing syndrome

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7
Q

what are 2 screening tests for Cushing syndrome?

A

dexamethasone suppression test
24 hr urine of cortisol and creatinine

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8
Q

what level of ACTH after a dexamethasone suppression test would indicate positive Cushing syndrome?

A

over 5

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9
Q

where is the problem if serum ACTH is low? what would we order?

A

adrenal glands
CT of adrenal

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10
Q

where is the problem if serum ACTH is high? what would we order?

A

pituitary gland
MRI of pituitary

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11
Q

what are 2 things that could cause high serum ACTH?

A

pituitary tumor
ectopic tumor

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12
Q

what would labs look like in Cushing syndrome? (5)

A

elevated serum + urine cortisol
ACTH varies
glycosuria
leukocytosis
hypokalemia

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13
Q

what is the treatment for Cushing Disease/ACTH dependent?

A

transphenoidal selective resection of pituitary adenoma

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14
Q

what is the treatment for an adrenal adenoma/ACTH independent?

A

unilateral adrenalectomy

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15
Q

what can patients develop with resection of pituitary, ectopic tumor, or adrenalectomy? what will the patient need?

A

cortisol withdrawal
hydrocortisone

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16
Q

what is the treatment for hypercortisolism when surgery is delayed, CI, or unsuccessful?

A

“block and replace”

adrenal enzyme inhibitor (ketoconazole) - block

hydrocortisone - replace

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17
Q

when the adrenal cortex is absent, destroyed, or dysfunctional and cannot make cortisol or aldosterone

A

primary adrenal insufficiency (AKA Addison Disease)

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18
Q

what is the most common cause of Addison Disease in the US?

A

autoimmune destruction

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19
Q

what is the most common cause of Addison Disease in the rest of the world?

A

infectious TB

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20
Q

a patient presents with fatigue, anorexia, N/V/D, headache, abdominal pain, weight loss, arthralgias, depression, and salt cravings. they also have hypotension and tachycardia. what are they likely experiencing?

A

primary adrenal insufficiency (Addison)

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21
Q

what symptom of primary adrenal insufficiency may precede all other symptoms by months to years?

A

hyperpigmentation

22
Q

what causes hyperpigmentation in Addison’s disease?

A

excess ACTH on melanocytes

23
Q

what will labs look like in a patient with primary adrenal insufficiency? (4)

A

low cortisol
high ACTH
low Na
high K

24
Q

how would DHEA and PRA present in a patient with primary adrenal insufficiency?

A

low serum DHEA
elevated PRA

25
Q

what diagnostic would we want to get if the primary adrenal insufficiency is not due to an autoimmune cause?

A

chest CT

26
Q

what is the imaging of choice to evaluate adrenal insuffiency?

A

CT adrenals

27
Q

what imaging is helpful in diagnosing the etiology of adrenal disease?

A

CT adrenals + FNA

28
Q

what will be found in a CT adrenals + FNA if the adrenal insufficiency is due to an autoimmune cause?

A

lymphocytes

29
Q

what will be found in a CT adrenals + FNA if the adrenal insufficiency is due to TB?

A

granulocytes

30
Q

what will be found in a CT adrenals + FNA if the adrenal insufficiency is due to a neoplasm?

A

mets

31
Q

what will be found in a CT adrenals + FNA if the adrenal insufficiency is due to a hemorrhage?

A

blood

32
Q

low ACTH, normal pigmentation and normal aldosterone production indicates what?

A

secondary adrenal insufficiency

33
Q

what is the treatment for all forms of adrenal insufficiency?

A

glucocorticoid replacement

34
Q

what specific medications can be used to treat chronic primary adrenal insufficiency? (3)

A

hydrocortisone
dexamethasone
prednisone

35
Q

what medication can be used for a patient with primary adrenal insufficiency that has hypotension, salt cravings, or hyponatremia?

A

fludrocortisone (mineralcorticoid replacement)

36
Q

what can be given to women with primary adrenal insufficiency + impaired mood or sense of well being, despite optimal glucocorticoid and mineralcorticoid replacement?

A

DHEA

37
Q

what should be done when a patient with adrenal insufficiency develops a febrile illness, needs a surgical procedure, or has an increased stress like serious illness or divorce?

A

give 2-3 times usual maintenance glucocorticoid dose for 3 days

38
Q

acute adrenal insufficiency = _____ = _____

A

adrenal crisis

emergency

39
Q

a patient presents with N/V, abdominal pain, hypotension, fever, hyponatremia, hyperkalemia, and hypoglycemia. what are they likely experiencing?

A

adrenal crisis

40
Q

what is the treatment for adrenal crisis? (2)

A

stress dose of IV hydrocortisone (100-300mg)
rapid bolus of normal saline

41
Q

what can be given to a patient in adrenal crisis who has hypoglycemia?

A

normal saline + dextrose

42
Q

what should ALL patients experiencing an adrenal crisis receive?

A

empiric antibiotics

43
Q

tumor in the adrenal medulla that secretes epinephrine and NE

A

pheochromocytoma

44
Q

what is the classic triad of symptoms for pheochromocytoma?

A

headache
palpitations
diaphoresis

45
Q

why is diagnosis critical in pheochromocytosis?

A

condition can lead to fatal hypertensive crisis + cardiac arrythmias

46
Q

what will labs look like in pheochromocytoma? (2)

A

elevated plasma metanephrines during spell

high urine catecholamines

47
Q

what diagnostics can we do to look for tumor in adrenal medulla for pheochromocytoma? (2)

A

abdominal MRI/CT
nuclear imaging

48
Q

what is the treatment of choice for pheochromocytoma?

A

adrenalectomy

49
Q

what is the pre-op treatment for pheochromocytoma (before adrenalectomy)?

A

alpha blocker OR CCB (10-14 days)

BB for tachycardia (AFTER HTN IS RESOLVED)

50
Q

when can a beta blocker be started for a patient with pheochromocytoma PRE-OP?

A

only after hypertension is resolved

Endocrinology (17 decks)

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