Adrenal, pituitary gland, DM, HLD

Question 1

What are the 3 zones of the adrenal gland and what does each zone produce

Answer 1

Zona Glomerulosa- Aldosterone

Zona Fasciculata- Cortisol

Zona Reticularis- Estrogens/Androgens

GFR- ACE

Question 2

MCC of addison’s disease in industrialized countries

Answer 2

Autoimmune- causes adrenal atrophy

Question 3

MCC of addison’s disease worldwide

Answer 3

Infection (TB*, HIV)

Question 4

Lack of cortisol AND aldosterone

Answer 4

primary adrenocortical insufficiency

(Addison’s)

Question 5

Lack of cortisol ONLY (aldosterone intact b/c of RAAS)

Answer 5

Secondary adrenocortical insufficiency

due to pituitary failure of ACTH secretion

Question 6

What is the MCC of secondary adrenocortical insufficiency and OVERALL insufficiency

Answer 6

exogenous steroid use

Question 7

S/s of what:

• Hyperpigmentation
• decr. aldosterone: Orthostatic hypotension, hyponatremia, hyperkalemia, metabolic acidocis
• decr. sex hormones in women

Answer 7

Addisons

Question 8

what will be seen on CMP in a patient with Addisons

Answer 8

Hyponatremia

HYPEKALEMIA

non anion gap metabolic acidosis

hypoglycemia

(aldosterone normally causes Na retention in exchange for K and H, so in Addisons this will happen in reverse)

Question 9

how do you dx adrenocortical insufficiency

Answer 9

Question 10

tx for Adrenocortical Insufficiency

Answer 10

Addisons: Glucocorticoids (Hydrocortisone) + Mineralcorticoids (Fludrocortisone)

2ry: Glucocorticoids only (Hydrocortisone)

Question 11

MCC Cushing’s Syndrome

Answer 11

Long term high dose corticosteroid therapy

Question 12

What are 3 endogenous causes of Cushing’s Syndrome (hypercortisolism)

Answer 12

Benign Pituitary Adenoma

ACTH secreting small cell lung tumor

Adrenal tumor (cortisol-secreting)

Question 13

What should be seen on a low-dose dexamethasone suppression test in Cushings disease

Answer 13

suppression (of ACTH)

(Dexamethasone is 4x more potent than cortisol)

Question 14

tx for pheochromocytoma

Answer 14

complete adrenalectomy

pre-op: nonselective α-blockade: phenoxybenzamine or phentolamine x 7-14 days followed by BBs to control HTN.

Question 15

tx for prolactinoma

Answer 15

Dopamine agonist (dopamine inhibits prolactin): Cabergoline or Bromocrpitine

Question 16

Tx for Acromegaly

Answer 16

TSS + Bromocriptine

Octreotide

Question 17

What does a somatotropinoma cause

Answer 17

Adults–> Acromegaly

Kids–> Gigantism

+ DM and glucose intolerance (GH incr. glucose)

Question 18

What test do you use to dx acromegaly

Question 19

What are 4 complications of acromegaly/gigantism

Answer 19

1. Diabetes
2. Congestive Heart Failure
3. GI cancers
4. Carpal Tunnel

Question 20

How do you screen for Acromegaly

Answer 20

Increased Insulin-like growth factor

Question 21

If you find insulin-like growth factor to be elevated, how do you CONFIRM acromegaly/gigantism?

Answer 21

Oral glucose suppression test (give glucose)

Incr. GH= Acromegaly

Question 22

What are the pre-prandial and post-prandial blood sugar goals in a patient with DM

Answer 22

Pre-prandial: 80-130

Post-prandial: <180

Question 23

MCC nephrogenic DI

(3 common causes)

Answer 23

MCC- lithium

amphotericin B

Demeclocycline

Question 24

Polyuria + polydipsia

nocturia

Hypernatremia (if decr. H20 intake)

Answer 24

Diabetes insipidus

(central= not making ADH,

Nephrogenic= kidney not responding to ADH)

Question 25

Tx for Central DI

Answer 25

**_Desmopressin_** (synthetic ADH) Carbamazepine

Question 26

Tx for nephrogenic DI

Answer 26

Na/protein restriction **_Hydrochlorothiazide_** Indomethacin sxs= hypotonic fluid

Question 27

What are the two primary manifestations of Growth hormone deficiency (dwarfism) in infancy

Answer 27

hypoglycemia and micropenis

Question 28

What is seen on labs in dwarfism

Answer 28

↓ GH, ↓ IGF1

Question 29

What is an important diagnostic test to order when evaluating a patient you believe to have dwarfism

Answer 29

x-ray of hand (to show bone age vs. chronological age bone age usu. \>2yrs behind chronological age

Question 30

What are 3 possible causes of hypercholesterolemia

Answer 30

Hypothyroidism Pregnancy Kidney failure

Question 31

What are 5 possible causes of hypertryiglyceridemia

Answer 31

DM ETOH obesity Steroids Estrogen

Question 32

When do you start screening for hyperlipidemia in those at **_higher risk_**? (HTN, smoking, FHx)

Answer 32

males: 20-25y/o females: 30-35y/o

Question 33

When do you start screening for hyperlipidemia in those at LOWER risk?

Answer 33

males: 35y/o females: 45y/o

Question 34

What risk calculator do you use to determine if someone should be started on a statin

Answer 34

ASCVD risk calculator

Question 35

When should someone be started on a statin

Answer 35

* DM 40-75y/o w/ LDL 70-189 * 40-75y/o WITHOUT CVD + \>7.5% 10yr risk * \>21y/o w/ LDL \>190 * Atherosclerotic cardiovascular dz

Question 36

What medication is best at increasing HDL

Answer 36

Niacin (may cause hyperglycemia)

Question 37

At what LDL level should someone over 21y/o be started on a statin

Answer 37

\>190

Question 38

What is the only lipid lowering agent safe to use in pregnancy

Answer 38

Bile acid sequestrants

Question 39

What condition are xanthomas (esp. xanthelasma) seen in ?

Answer 39

hypercholesterolemia

Question 40

What are the 2 high intensity statins

Answer 40

Atorvastatin 40-80mg Rosuvastatin 20mg

Question 41

What are considered moderate intensity statins

Answer 41

Atorvastatin 10mg Simvastatin 20-40mg