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Endo II > aldosteronism and phenochromocytomas > Flashcards

aldosteronism and phenochromocytomas Flashcards

1
Q

complications of hypokalemia

A

glucose intolerance dt decreased insulin release

DI d/t defective vassopressin signaling

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2
Q

albuterol and K

A

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

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3
Q

glomerulosa

A

aldosterone

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4
Q

fasiculata

A

cortisol

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5
Q

reticularis

A

Androgens

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6
Q

what is the ald>renin ratio in primary hyperaldosteronism

A

> 30

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7
Q

conns syndrome

A

primary hyperaldosteronism

5-10% of HTN patients

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8
Q

causes of conns

A

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

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9
Q

workup for primary aldosteronism

A
  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)
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10
Q

Tx of adenoma

A

surgery

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11
Q

Tx of hyperplasia

A

spironolactone or eplerenone

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12
Q

licorice

A

inhibits 11beta hydroxysterioid dehydrogenase 2

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13
Q

secondary aldosteronism

A

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

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14
Q

psudohyperaldosteronism

A 
low renin and aldosterone
liddles
cushings
exogenous steroids
CAH
licorice
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15
Q

bartters/gitelmans

A 
syndromes which cause pt to present in childhood like they r on diuretics
vomiting
dehydrated
increased renin
hypotensive
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16
Q

Liddles

A

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

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17
Q

Hirsutism

A

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

18
Q

causes of hirsutism

A 
decreased E
insulin
GH
obesity (PCOS)
hypothyroidism
glucocorticoids (cushings)
androgens
nephrotic syndrome
excessive activity of 5-alpha reductase
idiopathic/familial
19
Q

PCOS

A

LH/FSH >2 -> decreased E/T

20
Q

hypothyroidism

A

decreases SHGB and TRH induces prolactin

21
Q

ovarian/adrenal tumors

A

LH/FSH -> hyperthecosis

arrested development w/luteinized thecal cells over producing T

22
Q

drugs

A 
pheytoin
minoxidil
anabolic steroid
cyclosporine
OCPs
penicillin
23
Q

CAH

A

deficiency of 21 hyroxylase

24
Q

labs for hirsutism

A 
TSH
PRL
IGF-1
24 hr cortisol
T
DHEA
17OHP
25
Q

what will labs look like if idiopathic/hereditary

A

free and total T
DHEAS
17OHP
all normal

26
Q

PCOS labs

A

T mildly increased

DHEAS and 17OHP normal

27
Q

CAH labs

A

total T, DHEAS, 17OHP all increased

28
Q

causes of virilization

A

ovarian tumor
adrenal tumor
CAH

29
Q

labs for ovarian tumor

A

total T greatly increased with normal DHEAS and 17OHP

30
Q

adrenal tumor labs

A

greatly increased DHEAS

31
Q

CAH labs

A

total T, DHEAS, 17OHP all increased

32
Q

Tx for hirsuitism

A

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

33
Q

causes of non-essential HTN

A 
aldosteronism
licorice
myxedema and hypercalcemia
pheochromocytoma
steroid excess
hyperthyroid
34
Q

NE/epi can cause what

A

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

35
Q

how does NE/epi cuase hypotension

A

down regulation of alpha R -> hypotension

Epi -> B2 -> vasodilate

36
Q

how does NE/epi cause hypercalcemia

A

adrenergic stim of parathyroids or tumor itself releases PTH-rP

37
Q

Epi producing tumor

A

must be in adrenals

38
Q

NE producing tumor

A

anywhere in paraganglion chain

39
Q

Dx of pheo

A

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

40
Q

when should u Bx an incidentaloma?

A

when >6cm

pre-op eval should include plasma metanephrines and dexamethazone supression test

41
Q

causes of flushing

A

carcinoid
medullary carcinoma of thyroid
pheo

Endo II (15 decks)

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