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Clin Med II Final > Adrenal > Flashcards

Adrenal Flashcards

0
Q

Most common ectopic ACTH producing tumor

A

Small cell lung cancer

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1
Q

Cushing’s syndrome

A

Excessive cortisol

ACTH producing tumors located somewhere other than pituitary or adrenal tumor making excessive cortisol secretion

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2
Q

Cushing’s disease

A

Excessive ACTH

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3
Q

Weight gain, moon face, truncal obesity, buffalo hump, weakness, acne, weird hair, edema, HTN, insulin resistance

A

Cushing’s syndrome

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4
Q

Cortisol high

ACTH low

A

Adrenal hyperplasia or adrenal tumor

ACTH independent - adrenal glands not responding to feedback

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5
Q

Cortisol high

ACTH high

A

ACTH producing tumor - pituitary or ectopic

ACTH dependent

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6
Q

Gold standard for Cushing’s syndrome dx

A

24 hour urine free cortisol

> 125 is indicative of Cushing’s

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7
Q

Morning salivary cortisol

A

DECREASED in adrenal insufficiency

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8
Q

Late evening salivary cortisol

A

INCREASED in Cushing’s DISEASE

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9
Q

Adrenolytic agent that induces destruction of adrenocortical cells

Aka medical adrenalectomy

A

Mitotane

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10
Q

Blocks cortisol synthesis

A

Ketoconazole

Metyrapone

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11
Q

Most common cause for cushingoid symptoms

A

Exogenous steroid use

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12
Q

Cause of Cushing’s disease

A

ACTH producing pituitary adenoma

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13
Q

Findings that suggest Cushing’s

A 
Central obesity 
Striae 
Spontaneous ecchymosis 
Virilization 
Unexplained osteoporosis 
HTN 
New onset insulin resistance
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14
Q

First line tx of Cushing’s disease

A

Surgery

But medical management also available

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15
Q

Quick easy cheap screening test

A

Dexamethasone suppression test

16
Q

Most common cause of primary adrenal insufficiency

A

Addison’s disease

Autoimmune
All 3 depleted: glucocorticoid, mineralcorticoid, adrenal androgen replacement

17
Q

Most common cause of secondary adrenal insufficiency

A

Suppression of HPA axis through abrupt cessation of exogenous steroid

-adrenal gland can’t do its job becz not getting the right signals

18
Q

Drugs to reduce excess cortisol

A

Phenytoin
Ketoconazole
Opiates
Rifampin

19
Q

Hallmark tetrad of adrenal insufficiency

A

Weakness/fatigue
Weight loss/anorexia
Hyperpigmentation
Hypotension

20
Q

Late finding of adrenal insufficiency

A

Salt craving

Becz hyponatremia

21
Q

Weakness and fatigue
Hypoglycemia
Wt loss anorexia
N/V abd pain

A

Glucocorticoid deficiency

22
Q 
Na+ wasting (hyponatremia, salt craving) 
Hypovolemia 
Hyperkalemia 
Ortho static hypotension 
Mild met acidosis
A

Mineralcorticoid deficiency

23
Q

Loss of armpit hair and pubes in females

Amenorrhea

A

Adrenal androgen deficiency

24
Q

Hyperpigmentation

A

ACTH elevation in primary disease

Mostly seen in Addison’s

25
Q

Cortisol low

ACTH high

A

Addison’s disease: adrenal gland fail

  • adrenal glands attacked by autoimmune, pituitary keeps sending ACTH becz low cortisol
26
Q

Cortisol low

ACTH low

A

Hypopituitarism

-adrenal glands don’t get signal

27
Q

Gold standard in adrenal insufficiency dx

A

Cosyntropin stimulation test

28
Q

Conn’s syndrome

A 
Adrenalcortical adenoma (most) 
Or cortical hyperplasia 
Too much aldosterone 
HTN 
Hypokalemia
29
Q

Dx of Conn’s syndrome

Primary hyperaldosteronism

A

Elevated plasma and urine aldosterone
Low plasma renin
CT scan of adrenals - important to get imaging

30
Q

Tx of Conn’s syndrome

Very important to control HTN

A

Surgical removal of adenoma

Medical: spironolactone and antihypertensive agents until can get surgery

31
Q

Rare catecholamine producing tumor of neurochromaffin cells

A

Pheochromocytoma

Sporadic or familial
Fatal if not tx

32
Q

Paragangliomas

A

Extra-adrenal pheochromocytomas

As opposed to majority which are on adrenal medulla

33
Q

Pt complains of terrible panic attacks that have increased in frequency. Feels like he is going to die for 30-40 minutes at a time. He has also been experiencing profound HTN

A

Pheochromocytoma

Attacks may be precipitated by displacing abdominal contents like bending over

34
Q

If you have a pt with HTN that is refractory to conventional therapy

A

W/u for excessive catecholamine

35
Q

Dx a/w Pheochromocytoma

A

Neurofibromatosis (May see cafe au late spots)

MEN2

36
Q

Gold standard for dx Pheochromocytoma

A

24 hour urine catecholamines, metanephrines and vanillymadelic acid (VMA)

37
Q

Pheochromocytoma crisis initial tx

A

IV nitroprusside

38
Q

“Chemical sympathectomy”

To stabilize until surgery for Pheochromocytoma
Surgery is definitive tx

A

Start w/ pure alpha blocker
Followed by beta blocker

Ex: phenoxybenzamine then propanolol

Clin Med II Final (6 decks)

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