Cushings Flashcards Preview

Endocrine > Cushings > Flashcards

Flashcards in Cushings Deck (32)
1

ACTH independent cushings is?

ppl who are taking exogenous steroids

2

ACTH dependent cushings is?

endogenous causes

3

90% of ACTH-dependent cushings is caused by?

pituitary issues

4

does ectopic ACTH or Cushings disease cause more elevated ACTH?

ectopic ACTH

5

first step to dx cushings

confirm hypercortisolemia

6

test for cushings should be done inpatient or outpatient

outpatient (less stress)

7

tests for hypercortisolemia (3)

1. 24 hr urine collection - cortisol
2. 11 pm salivary or serum cortisol
3. low dose dexamethasone suppresion test

8

24 hr urinary free cortisol under 50, risk of cushings?

unlikely

9

24 hr urinary free cortisol 50-150, risk of cushings?

possible

10

24 hr urinary free cortisol >150, risk of cushings?

likely

11

does a normal 24 hr urinary free cortisol r/o cushings?

no

12

what is pseudo cushings

elevated cortisol levels from an underlying cause that stimulates HPA

13

best test to do for pseudo cushings?

overnight low dose DST

14

the midnight salivary test result of _______r/o cushings

under 5

15

the midnight salivary test result of _______indicates possibility of cushings

5-7.5

16

the midnight salivary test result of _______likely points to cushings

>7.5

17

dexamethasone suppression test ____ is normal

under 2

18

dexamethasone suppression test ____ is suspicious of cushings

3-10

19

dexamethasone suppression test ____ is likely cushings

>10

20

how to subtype a case of cushings

measure ACTH

21

how to image a pituitary lesion

MRI

22

to to image an adrenal lesion or ectopic lesion

CT

23

next step in w/u of high cortisol, low ACTH

CT to differentiate unilateral vs bialteral disease

24

tx of ACTH-independent cushings - adrenal adenoma

surgery + post-op tx of adrenal insufficiecy

25

ACTH dependent cushings - tests to differentiate b/w pituitary vs ectopic (2)

1. inferior petrosal sinus sampling
2. high dose dexamethasone test

26

if patient shows no suppression with high dose dexamethasone test?

ectopic

27

if patient shows some suppresion of ACTH with high dose dexamethasone

pituitary cause

28

inferior petrosal sinus:peripheral concentration of ACTH >2:1 then?

pituitary source

29

most common type of pituitary irradiation

stereotactic radiosurgery/gamma knife

30

MOA: blocks conversion of cholesterol to pregnenolone

aminoglutethimide

31

MOA: blocks 11 beta hydroxylase

1. ketoconazole
2. mitotane

32

a large adrenal adenoma would dictate what type of surgery

open laparatomy & right adrenalectomy