aldosteronism and phenochromocytomas

Question 1

complications of hypokalemia

Answer 1

glucose intolerance dt decreased insulin release

DI d/t defective vassopressin signaling

Question 2

albuterol and K

Answer 2

lowers serum potassium by stimulating release of insulin which shifts K into cells

Question 3

glomerulosa

Answer 3

aldosterone

Question 4

fasiculata

Answer 4

cortisol

Question 5

reticularis

Answer 5

Androgens

Question 6

what is the ald>renin ratio in primary hyperaldosteronism

Answer 6

> 30

Question 7

conns syndrome

Answer 7

primary hyperaldosteronism

5-10% of HTN patients

Question 8

causes of conns

Answer 8

adrenal adenoma
unilateral or bilateral hyperplasia
genetic defect with overly strong effect of ACTH on aldosterone

Question 9

workup for primary aldosteronism

Answer 9

1. 8am renin (if high, not primary hyperaldosteronism)
2. if renin low stand for 3 hours then take A/R ratio, if >30 they have primary hyperaldosteronism
3. Confrim with Na loading and 24hr urin for aldosterone, if >20 confirmed
4. adrenal CT or adrenal vv sampling, if both sides have = aldosterone secretion then they have b/l adrenal hyperplasia, if only unilateral they have adenoma
5. if you can’t do imaging use postural stimulation test (if bl hyperplasia aldosterone will increase more)

Question 10

Tx of adenoma

Answer 10

surgery

Question 11

Tx of hyperplasia

Answer 11

spironolactone or eplerenone

Question 12

licorice

Answer 12

inhibits 11beta hydroxysterioid dehydrogenase 2

Question 13

secondary aldosteronism

Answer 13

high renin and aldosterone
diuretics (excluding K sparring)
vomiting
nasogastric suction

Question 14

psudohyperaldosteronism

Answer 14

low renin and aldosterone
liddles
cushings
exogenous steroids
CAH
licorice

Question 15

bartters/gitelmans

Answer 15

syndromes which cause pt to present in childhood like they r on diuretics
vomiting
dehydrated
increased renin
hypotensive

Question 16

Liddles

Answer 16

gain of fnx mutation, apical NaCh always open
HTN with low K, low R, and low A
pseudohyperaldosteronism

Question 17

Hirsutism

Answer 17

usually dt decreased sex hormone binding globlin -> increased free T

Question 18

causes of hirsutism

Answer 18

decreased E
insulin
GH
obesity (PCOS)
hypothyroidism
glucocorticoids (cushings)
androgens
nephrotic syndrome
excessive activity of 5-alpha reductase
idiopathic/familial

Question 19

PCOS

Answer 19

LH/FSH >2 -> decreased E/T

Question 20

hypothyroidism

Answer 20

decreases SHGB and TRH induces prolactin

Question 21

ovarian/adrenal tumors

Answer 21

LH/FSH -> hyperthecosis

arrested development w/luteinized thecal cells over producing T

Question 22

drugs

Answer 22

pheytoin
minoxidil
anabolic steroid
cyclosporine
OCPs
penicillin

Question 23

CAH

Answer 23

deficiency of 21 hyroxylase

Question 24

labs for hirsutism

Answer 24

TSH
PRL
IGF-1
24 hr cortisol
T
DHEA
17OHP

Question 25

what will labs look like if idiopathic/hereditary

Answer 25

free and total T DHEAS 17OHP all normal

Question 26

PCOS labs

Answer 26

T mildly increased | DHEAS and 17OHP normal

Question 27

CAH labs

Answer 27

total T, DHEAS, 17OHP all increased

Question 28

causes of virilization

Answer 28

ovarian tumor adrenal tumor CAH

Question 29

labs for ovarian tumor

Answer 29

total T greatly increased with normal DHEAS and 17OHP

Question 30

adrenal tumor labs

Answer 30

greatly increased DHEAS

Question 31

CAH labs

Answer 31

total T, DHEAS, 17OHP all increased

Question 32

Tx for hirsuitism

Answer 32

OCPs with progestins antiandrogens: spironolactone, flutamide, dinasteride metformin GnRH agonists

Question 33

causes of non-essential HTN

Answer 33

``` aldosteronism licorice myxedema and hypercalcemia pheochromocytoma steroid excess hyperthyroid ```

Question 34

NE/epi can cause what

Answer 34

neutrophilia hyperglycemia -> decreased insulin output and increased liver glucose production hypotension hypercalcemia

Question 35

how does NE/epi cuase hypotension

Answer 35

down regulation of alpha R -> hypotension | Epi -> B2 -> vasodilate

Question 36

how does NE/epi cause hypercalcemia

Answer 36

adrenergic stim of parathyroids or tumor itself releases PTH-rP

Question 37

Epi producing tumor

Answer 37

must be in adrenals

Question 38

NE producing tumor

Answer 38

anywhere in paraganglion chain

Question 39

Dx of pheo

Answer 39

plasma metanephrine 24-hour urinary catecholamine CT, MRI, MIBG whole body scan for mets

Question 40

when should u Bx an incidentaloma?

Answer 40

when >6cm | pre-op eval should include plasma metanephrines and dexamethazone supression test

Question 41

causes of flushing

Answer 41

carcinoid medullary carcinoma of thyroid pheo