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adrenal and pituitary pp Flashcards

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1
Q

adrenal glands are located where

A

on top of kidneys

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2
Q

adrenal glands produce what hormones

A

cortisol
aldosterone
adrenaline and NE
DHEA and androgenic steroids

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3
Q

these hormones help regulate

A

metabolism
BP
bodys response to stress

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4
Q

what secretes catecholamines, Epi, and NE

A

adrenal medulla

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5
Q

arenal cortex zones

A

zona glomerulosa
zona fasciculata
zona reticularis

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6
Q

hypercortisolism is known as

A

Cushings syndrome

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7
Q

adrenal insufficiency is know as

A

Addisons disease

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8
Q

addisons disease s/s

A

bronze skin
changes in body hair
GI disturbances
weakness
hypoglycemia
hypotension
weight loss

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9
Q

cushings disease s/s

A

personality changes
moon face
buffalo hump
acne
ED
increase susceptibility to infection
gynecomastia
fat deposits an face and back of shoulders
osteoporosis
hyperglycemia
CNS irritability
NA and fluid retention
thin extremities
GI distress (increased acid)
amenorrhea
hirsutism
thin skin
bruising

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10
Q

elevated glucocorticoid levels
due to exogenous administration or endogenous production

A

cushings

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11
Q

cushings risk factors

A

tumor on adrenal gland
corticosteroid use

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12
Q

endogenous cushings
ACTH dependent and independent

A

dependent- pituitary adenomas or ectopic ACTH production leading to adrenal hyperplasia
independent- adrenal adenomas or carcinomas

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13
Q

cushing presentation

A

central obesity and facial rounding
peripheral obesity and fat accumulation
buffalo hump
moon face
muscle weakness
HTN
glucose intolerance
psychiatric changes
osteoporosis

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14
Q

cushing diagnosis tests

A

24h urinary free cortisol (UFC)
low dose dexamethasone suppression test (DST)
midnight plasma control
late night (11pm) salivary cortisol

masses and nodules via CT scan or MRI

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15
Q

what drugs inhibit 11- beta hydroxylase

A

metyrapone
etomidate

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16
Q

what drug inhibits CYP450 enzymes, including 11 beta hydroxylase and 17 alpha hydroxylase

A

ketoconazole

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17
Q

which drug can lead to increased plasma ACTH initially

A

metyrapone

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18
Q

what drug inhibit 11 hydroxylation of 11 deoxycortisol and 11 deoxycorticosterone in the adrenal cortex

A

mitotane

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19
Q

what drug is a progesterone and glucocorticoid receptor antagonist

A

mifepristone

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20
Q

mifepristone ADE

A

fatigue
nausea
HA
arthralgia
peripheral edema
endometrial thickening
reduced serum potassium

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21
Q

closely monitor this while on meds

A

24hr UFC
serum cortisol
steroid secretion (except mifepristone)

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22
Q

decreased glucocorticoid levels

A

addisons disease

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23
Q

addisons disease s/s

A

weight loss
low BP
hyperpigmentation
hyperkalemia
hyponatremia
N/V/D

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24
Q

addisons disease risk factors

A

cancer
infection

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25
s/s of adrenal crisis
fever syncope convulsions hypoglycemia hyponatremia severe vomiting diarrhea
26
destruction of all regions of adrenal cortex from autoimmune process
primary adrenal insufficiency
27
primary adrenal insufficiency results in deficiencies in
cortisol androgens compensatory increases in CRH and ACTH
28
primary adrenal insufficiency causes
autoimmune dysfunction TB medications such as- ketoconazole, phenytoin, rifampin, phenobarbital
29
secondary adrenal insufficiency results from
excessive corticosteroid us pituitary problems meds such as- mirtazapine and progestins
30
s/s of glucocorticoid deficiency
weight loss malaise abdominal pain depression
31
s/s of mineralocorticoid deficiency
dehydration hypotension hyperkalemia salt craving
32
patients on glucocorticoid replacement should be monitored
every 6-8 weeks
33
acute adrenal insufficiency causes
stress surgery infection trauma abrupt withdrawal of chronic glucocorticoid therapy
34
patients with adrenal insufficiency should carry what in case of emergency or times of physical stress
injectable hydrocortisone glucocorticoid suppositories
35
HPA suppression is unlikely when
glucocorticoid therapy less than 3 weeks alternate day prednisone at doses less than 10mg prednisone doses lower than 5mg/day
36
taper regimen for- <2 week therapy
no taper needed
37
taper regimen for- 40mg/day
reduce dose 5-10mg/day every 1-2 weeks
38
taper regimen for- 20-40mg/day
reduce dose 5mg/day every 1-2 weeks
39
taper regimen for- 10-20mg/day
reduce dose 2.5mg/day every 2-3 weeks
40
taper regimen for- 5-10mg/day
reduce dose 1mg/day every 2-4 weeks
41
taper regimen for- <5mg/day
reduce dose by 0.5mg/day for 2-4 weeks can alternate days
42
elevated aldosterone levels due to tumors or disease
hyperaldosteronism
43
where is aldosterone produced
zona glomerulosa of the adrenal cortex
44
function of aldesterone
controlling BP, blood volume, and electrolyte balance regulates the balance of sodium and potassium in the body
45
sodium retention
aldosterone acts on the distal tubules and collecting ducts, where it increases the reabsorption of sodium from the urine back into the bloodstream the promotes the retention of sodium, leading to increased extracellular fluid volume and BP
46
potassium excretion
aldosterone enhances the secretion of potassium into the urine this helps maintain appropriate potassium levels
47
water retention
by increasing sodium reabsorption, aldosterone indirectly promotes the retention of water, the reabsorption leads to the osmotic retention of water, leading to increased blood volume and BP
48
acid base balance
aldosterone enhances the secretion of hydrogen and reabsorption of bicarbonate this helps maintain proper pH in the blood
49
primary hyperaldosteronism
excessive aldosterone secretion due to adrenal gland issues, often due to tumors or rare conditions
50
secondary hyperaldosteronism
due to extra adrenal factors stimulating aldosterone secretion causes- HF, cirrhosis, renal artery stenosis, excessive potassium intake
51
hyperaldosteronism s/s
muscle weakness fatigue paresthesia HA polydipsia nocturnal polyuria HTN potential tetany/paralysis elevated aldosterone hypernatremia hypokalemia hypomagnesemia elevated bicarbonate glucose intolerance
52
nonselective aldosterone receptor antagonist
spironolactone
53
spironolactone ADE
GI discomfort impotence gynecomastia menstrual irregularities hyperkalemia
54
selective aldosterone receptor antagonist
eplerenone
55
elerenone ADE
fewer sex-steroid dependent effects (gynecomastia menstruation)
56
potassium sparing diuretic
amiloride
57
what is the preferred agent for hyperaldosteronism
spironolactone
58
what should be monitored with these drugs
SCr serum potassium BP
59
what drug is preferred in pregnancy
eplerenone
60
acromegaly GH deficiency hyperprolactinemia
pituitary disorders
61
pituitary glad disorders
damage or destruction of the gland a tumor may result in excess secretion of a hormone or may compress the gland and suppress adequate hormone release
62
breast development for milk production induces lactation dopamine prevents/suppress production
prolactin
63
high levels suppress lactation levels drop postpartum
estrogen and progesterone
64
hyperprolactinemia s/s
women- excessive undesired milk production (galactorrhea) infertility vaginal dryness oligomenorrhea males- ED loss of muscle mass and body hair enlarged breasts low testosterone
65
hyperprolactinemia risk factors
hypothyroidism (untreated can contribute to elevated prolactin levels) breastfeeding tumors drugs- dopamine receptor antagonists: antipsychotics, metoclopramide, risperidone (the worst) prolactin stimulations: methlydopa, estrogens, opioids, TCAs, isoniazid, cimetidine
66
hyperprolactinemia treatment
if hyperthyroidism- thyroid replacement dopamine agonists- bromocriptine and cabergoline
67
dopamine agonists ADE
common: nausea hypotension mental fogginess less common: nasal stuffiness depression Raynaud phenomenon alcohol intolerance constipation uncommon: impulse control disorder valvular heart disease cerebrospinal fluid rhinorrhea side effects cane avoided by starting lower and titrating, giving with food, and at bedtime

Endocrine (32 decks)

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