Adrenal Gland

Question 1

What is the most common cause of ACTH-dependent Cushing’s syndrome?

Answer 1

Pituitary adenoma

Question 2

What are some important causes of ACTH-independent Cushing’s syndrome? (excess cortisol)

Answer 2

Adrenal tumor (nodular hyperplasia)
Neuroendrocrine tumors (ie: MEN I, Zollinger Ellison
Syndrome)
Pheochromocytoma

Question 3

What is the initial test for Cushing’s disease? The gold standard?

Answer 3

Dexamethasone suppression test; 24 hr urine free cortisol

Question 4

When do you perform a salivary sample looking for Cushing’s? What result are you expecting for Cushing’s? What can skew the results?

Answer 4

11:00 PM 3 nights in a row; it will be high; high stress and heavy exercise prior to tests

Question 5

What is considered first line treatment for Cushing’s disease?

Answer 5

Surgery to remove adrenal or pituitary tumor

Question 6

What is the most common cause of primary adrenal insufficiency? Secondary?

Answer 6

Acute/chronic destruction due to autoimmune abs; Quick cessation of steroid

Question 7

What is the hallmark triad of Addison’s disease?

Answer 7

Weakness, weight loss/anorexia, hyperpigmentation, hypotension

Question 8

What is the gold standard test of adrenal insufficiency?

Answer 8

cosynotropin stim test

Question 9

Which salivary sampling test evaluates for Addison’s?

Answer 9

Morning salivary x 3 days

Question 10

What are three important findings on a CMP in Addison’s?

Answer 10

HyperK+, HyperCa+, HypoNa+

Question 11

What are important findings in Addison’s on a CBC?

Answer 11

Anemia and eosinophilia

Question 12

What infectious processes do you need to rule out in an adrenal insufficiency workup?

Answer 12

Cocci and TB

Question 13

What other hormone levels should be checked with adrenal insufficiency?

Answer 13

TSH, LH, prolactin, and FSH

Question 14

What scans for adrenal insufficiency should be done?

Answer 14

CT of adrenals, MRI of pituitary

Question 15

What is the most common cause of primary hyperaldosteronism?

Answer 15

adrenocortical adenoma

Question 16

What are sx of Conn’s syndrome?

Answer 16

HTN, Low K+, weakness, HA, etc.

Question 17

What are labs for Conn’s syndrome?

Answer 17

Elevated plasma and urine aldosterone
Low plasma renin levels
Ct scan of adrenals to evaluate for adrenal
adenoma

Question 18

What are classic signs of pheo?

Answer 18

Paroxysmal anxiety attacks, SEVERE HTN, HA

Question 19

Besides a plasma and urine catecholamine check, what other test is important to check for pheo?

Answer 19

CLONIDINE SUPRESSION TEST

Question 20

How do you tx a pheo crisis?

Answer 20

IV nitroprusside

Question 21

How do you prep pheo for surgery?

Answer 21

alpha and beta blockers

Question 22

What labs should you run looking for sellar masses and you are concerned about hypersecretion?

Answer 22

Prolactin, IFG-1, GH, TSH, Cortisol, ACTH

Question 23

What is the typical cause of hyposecretion? What if you are concerned with hyposecretion?

Answer 23

USUALLY a hypothalmic or pituitary lesion, not and adenoma; Same and hyper but include FSH/LH, testosterone, estradiol, ADH

Question 24

What is the standard imaging for sellar mass? What about calcification?

Answer 24

MRI of sella; CT is better for calcification

Question 25

When do prolactin levels peak?

Answer 25

during REM sleep and in AM

Question 26

What are signs and sxs of excess prolactin?

Answer 26

visual, HA, thyroid probs

Question 27

What is the treatment for excess prolactin?

Answer 27

Dopamine agonist BROMOCRIPTINE

Question 28

What is a surgical tx for excess prolactin? What is to be watched for post op?

Answer 28

Transphenoidal resection; SIADH

Question 29

What should a w/u for acromegaly include?

Answer 29

Full hormone; HYPERCALCIURIA is common | MRI of brain should be the initial study.

Question 30

If serum GH/IGF levels are high, what should be done to evaluate cause? What is a positive test?

Answer 30

Suprression test/2 hr glucose test; GH remaining high after glucose admin

Question 31

What are two treatments for GH increase?

Answer 31

``` somatostatin analogues (octreodide and lanreotide) GH RECEPTOR AGONISTS (pegvisomant) ```

Question 32

What is the most effective method for rapid GH reduction?

Answer 32

surgery

Question 33

What is the test of choice for adult-onset GH deficiency?

Answer 33

Arginine-growth hormone-releasing hormone

Question 34

How do you treat adult-onset GH deficiency?

Answer 34

DON'T TX unless you know cause, MOST DON'T NEED TX! Use recomb GH

Question 35

Hypopit due to inflammation causes deficiency in which hormones?

Answer 35

GH, GnRH, AVP

Question 36

Hypopit due to infection causes deficiency in which hormones?

Answer 36

can be all or just a few

Question 37

What is the cause of Sheehan's syndrome?

Answer 37

Post-partum blood loss, pan-hypotituitarism

Question 38

Labs of DI

Answer 38

High osmolarity of plasma, low osmolarity of urine, dehydration

Question 39

Labs of SIADH

Answer 39

High osmol of urine, low osmol of plasma

Question 40

What drugs can increase cortisol levels?

Answer 40

estrogen (PREGNANCY), amphetamines, prednisone, spiro

Question 41

What drugs can decrease cortisol?

Answer 41

androgens, lithium, levodopa

Question 42

What is considered a below normal test result on a cosynopropin stimulation test?

Answer 42

a rise in cortisol of <7 above baseline

Question 43

ROCH | For bilateral adrenal hyperplasia (Cushings), what should a prolonged dex test show? Rapid plasma?

Answer 43

50% reduction of plasma cortisol and urine 17-OCHS levels; No change in cortisol

Question 44

What do you use for imaging adrenals? What is the most accurate?

Answer 44

CT; MRI

Question 45

High serum prolactin can have which effects?

Answer 45

Can suppress GnRH and FSH production hypogandism, amenorrhea | Can overstimulate mammary glands galactorrhea/gynecomastia due to engorgement

Question 46

In which diseases should you consider a prolactin workup?

Answer 46

``` –Amenorrhea or Dysfunctional uterine bleeding –Hypogonadism –Infertility –Hypothyroid –Adrenal disease –Galactorrhea –Low libido/sexual or erectile dysfunction –Vision loss or changes/headaches –Epilespy/Seizure disorder –Pituitary mass ```

Question 47

Stimulators of GH release

Answer 47

``` –Growth hormone releasing hormone (GHRH) –Sleep –Exercise –Hypoglycemia –Dietary protein –Estradiol –Arginine ```

Question 48

Inhibitors of GH release

Answer 48

–Somatostatin from the periventricular nucleus –Circulating concentrations of GH and IGF-1 (negative feedback) –Dietary carbohydrate –Glucocorticoids

Question 49

What study is used to evaluate the pituitary? When is a micro and macroadenoma considered?

Answer 49

MRI; micro 1 cm