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Master the boards: Endocrinology > Adrenal Disorders > Flashcards

Adrenal Disorders Flashcards

(47 cards)

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1
Q

What term can be used interchangeably with Hypercortisolism?

A

Cushing Syndrome

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2
Q

What is Cushing Disease?

A

Pituitary overproduction of ACTH

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3
Q

What are the most common causes of Hypercortisolism?

A

Pituitary ACTH (cushing disease)
Adrenals
Unknown source
Ectopic ACTH: Cancer, Carcinoid

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4
Q

What are the common symptoms of Hypercortisolism?

A

Fat redistribution
Skin changes
Osteoporosis
Hypetension
Menstrual disorders
Erectile dysfunction
Cognitive disturbance
Polyuria

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5
Q

What is the first step in diagnosing Hypercortisolism?

A

Establish the presence of Hypercortisolism

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6
Q

What is the most accurate test to confirm the presence of Hypercortisolism?

A

24 hour urine cortisol
-if not an option choose 1-mg overnight dexamethasone suppresion test

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7
Q

What is the 2nd step in diagnosing hypercortisolism?

A

Establishing the cause

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8
Q

What is the best initial test to help determine the cause or location of hypercortisolism?

A

ACTH testing

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9
Q

What does decreased ACTH in Hypercortisolism indicate?

A

Adrenal source

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10
Q

What does Elevated ACTH with hypercortisolism indicate?

A

Pituitary source or Ectopic production

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11
Q

How can you confirm a pituitary source of Hypercortisolism?

A

Cortisol will suppress with high-dose dexamethasone

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12
Q

How can you confirm Ectopic Cortisol Production?

A

Cortisol will not suppress with high-dose dexamethasone

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13
Q

What can you do once you confirm the source of cortisol with biochemical tests?

A

MRI or Petrosal sinus sampling

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14
Q

What are the actions of Cortisol?

A

Anti-insulin and aldosterone-like effect to excrete potassium and hydroegn

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15
Q

What lab abnormalities can Cortisol Cause?

A

Hyperglycemia, Hyperlipidemia
Hypokalemia, Metabolic Alkalosis
Leukocytosis

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16
Q

How do you treat Hypercortisolism?

A

Surgical removal of the source

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17
Q

What type of surgery is performed for pituitary sources of hypercortisolism?

A

Transsphenoidal surgery

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18
Q

What type of surgery is performed for adrenal sources of Hypercortisolism?

A

Laparoscopic surgery

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19
Q

What drug can be used if surgery is not successful for hypercortisolism?

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A

Pasireotide (somatostain analog)

20
Q

What drug can be used for hypercortisolism if surgery is not possible?

Study These Flashcards
A

Mifepristone: inhibits cortisol-R throughout the body

21
Q

What happens to ACTH level with adrenal sources of Hypercortisolism?

22
Q

What happens to ACTH level with Pituitary sources of Hypercortisolism?

23
Q

What happens to ACTH level with Ectopic sources of Hypercortisolism?

24
Q

What should you do to evaluate and adrenal Incidentaloma?

Study These Flashcards
A

Metanephrines in blood/urine to rule out Pheo

Renin and aldosterone to r/o hyperaldosteronism

1mg overnight dexamethasone suppression test

25
What is another term for Acute adrenal insuffiency?
Adrenal Crisis
26
What is another term for Chronic Adrenal Insufficiency?
Addison Disease
27
What are common causes of Acute Adrenal Crisis?
Hemorrhage, surgery, hypotension, trauma Sudden removal of chronic high-dose prednisone Loss of Pituitary
28
What are common causes of Chronic Adrenal Insufficiency (Addison)?
Autoimmune destruction of the gland Infection (TB) Adrenoleukodystrophy Metatastic cancer to the adrenal gland
29
What does low ACTH with low cortisol indicate?
Pituitary failure
30
What does high ACTH with low cortisol indicate?
Primary adrenal failure
31
What are common symptoms of Hypocortisolism?
Weakness, Fatigue, altered mental status, nausea, vomiting, anorexia, hypotension, hyponatremia and hyperkalemia
32
What are specific symptoms of Acute adrenal crisis?
Profound hypotension, fever, confusion and coma
33
What are specific symptoms of Addison disease (Chronic adrenal insufficiency)?
Hyperpigmentation over long periods of time
34
What electrolyte disturbances can be caused by hypocortisolism?
Hypoglycemia Hyperkalemia Metabolic acidosis Hyponatremia High BUN
35
What is the most specific test of adrenal function in Hypocortisolism?
Cosyntropin stimulation test
36
How do you treat Hypocortisolism?
Replace steroids with Hydrocortisone If needed add Fludrocortisone Mineralocorticoid supplements
37
What is primary Hyperaldosteronism?
Autonomous overproduction of aldosterone despite a high blood pressure with low renin activity
38
What are the most common cause of Primary Hyperaldosteronism?
Solitary Adenoma and Bilateral Hyperplasia
39
What is commonly seen in Primary Hyperaldosteronism?
High BP + low K: muscular weakness or diabetes insipidus from low K
40
How do you diagnose Primary Hyperaldosteronism?
CT of the adrenals after biochemical testing to confirm -low potassium -low renin -aldosterone to renin ratio >20:1 and aldosterone >15 -High aldosterone despite a high-salt diet
41
What lab values must be confirmed to diagnose Primary Hyperaldosteronism?
Low K Low Renin Aldosteone: renin >20:1 + Aldosterone >15 High aldosterone despite a high-salt diet
42
What is the most accurate test to diagnose Primary Hyperaldosteronism?
Sample of venous blood draining the adrenals: will have high aldosterone level compared to the vena cava
43
How do you treat Primary Hyperaldosteronism?
Laparoscopy for unilateral adenoma Eplerenone or Spironolactone for b/l hyperplasia and those who cannot have surgery Amiloride (less effective)
44
What is a Pheochromocytoma?
Nonmalignant lesion of the adrenal medulla that autonomously overproduces catecholamines despite a high BP
45
How does Pheochromocytoma present?
Episodes of HTN, Headache, sweating, palpitations, tremor and tachycardia
46
What is the best initial test for Pheochromocytoma?
Plasma Metanephrines
47
What is the best initial therapy for Pheochromocytoma?
Phenoxybenzamine: alpha blocker followed by beta blockers Laparoscopic removal of tumor

Master the boards: Endocrinology (8 decks)

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