Darrow, pheo, hirsuitism, aldosteronism Flashcards Preview

endoII exam2 > Darrow, pheo, hirsuitism, aldosteronism > Flashcards

Flashcards in Darrow, pheo, hirsuitism, aldosteronism Deck (56):
1

43 F uncontrolled HTN, rash on wrist, 4th heart sound, K low, HCO3 high,Mg low
acid base state?

hypokalemic alkalosis

2

if you are hypokalemic how does that affect insulin

decreases insulin secretion leading to glucose intolerance

3

what type of DI does hypokalemia cayse

nephrogenic because defective activation of renal adenyl cyclase

4

why is K drawn slowly without vacutainer

fast will cause hemolysis

5

alubuterol affects on K

lower serum K by stimulating release of insulin

6

What stimulates the glomerulosa to produce aldosterone

ANG II and K+

7

what inhibits glomerulosa

ANP= less aldosterone

8

what stimulates the fasiculata and reticularis

ACTH

9

what do you expect renin level to be if aldosterone is high

low because neg feedback

10

what is the standing up test for aldosterone renin

keep patient upright for 3 hours to cause rise in renin
if the aldosterone: renin ratio>30 it is most likely primary hyperaldosteronism

11

Conns syndrome

primary hyperaldosteronism

12

causes of conns syndrome

adrenal ademoa
unilateral or b/l hyperlpasia
genetic defect with overly strong effect of ACTH on aldosterone production

13

what is a good Dx test for primary aldosteronism

24 hour urine collection for aldosterone (>12 confirmatory)
Na loading before

14

how do you differentiate adenoma from b/l adrenal hyperplasia

postural sitmulation test

15

what is postural stimulation test

measure aldosterone while patient laying down then walk around 3 hours and if see rise in aldosterone then responding normal so hyperplasia
an adenoma would not respond

16

how to Tx patient with adrenal hyperplasia causing primary hyperaldosteronisms

meds- spironolactone

17

licorice effects on adrenals

inhibits 11betaHSD2 which converts cortisol to cortisone
so allows cortisol to drive mineralocortiocoid R leading to HTN and low renin/aldosterone

18

increased renin and aldosterone with alkalosis could be what

secondary aldosteronism: diuretics, Bartters and Gitelman,
vomiting
nasogastric suction

19

what are causes of pseudohyperaldosteronisms

liddles
cushings exogenous steroids
CAH
licorice

20

renin and aldosterone levels in pseduohyperaldosteronism

both decreased

21

What is liddles syndrome

gain of function in Na channel which inc K secretion and dec aldosterone and renin
pseudohyperaldosteronism

22

22 y.o F with acne, hirsutism, irregular menses,, acanthosis nigricans and apple shape
lab show inc testosterone with normal DHEA and 17OHP
next test

FSH LH

23

LH/FSH >2 22 y.o F with hirsutism

problem with follicular cell development in ovaries, Polycycstic ovary syndrome

24

majority of hirsutism is caused by what

decreased sex hormone binding globulin (increased free testosterone)

25

if there is not a dec in sex hormone binding globulin what could cause hirsutism

excessive activity of 5 alpha reductase

26

common causes of hirsutism

PCOS
drugs: pheytoin
idiopathic/familial

27

common causes virilization

ovarian/adrenal tumors

28

What labs will you do for PCOS

testosterone, LH/FSH
DHEAS
17 OHP

29

what labs do you do for CAH

total testosterone, DHEAS, 17OHP all increased

30

what labs do you do for patients with hirsutism in general

TSH, PRL, IGF-1, 24 hr cortisol, testosterone, DHEAS and 17OHP

31

in virilization what labs do you want to order

testosterone, DHEA and androstenedioine

32

ovarian utmor will have what lab results

increased total testosterone with normal DHEAS and 17OHP

33

adrneal tumor will have what lab results

increased DHEAS

34

what will lab results be in CAH

total testosterone and DHEAS and 17OHP will be increased

35

if 17 OHP is >500

CAH

36

Tx for hirsutism

OCPs with progestins to increase estrogen
antiandroges: spironolactone, flutamide, finasteride, metformin, GnRH agonists

37

how does insulin affect androgens

triggers ovarian androgen production and reduces SHBG

38

what occurs in 21 hydroxylase deficiency

shift to zona reticularis
masculinizaiton and hypotension

39

what occurs in 17 hydroxylase deficiency

shift to the glomerulosa, alot of aldosterone, HTN

40

what happens in 11 beta hydroxylase deficiency

HTN and masculinization

41

how does congential adrenal hyperplasia happen

lose cortisol negative feedback so massive increases of androgens with no feedback from cortisol to hypothalamus or pituitary

42

palpitations, sweating, HA

pheochromocytoma

43

cafe au lait spots and nodules

neurofibromas

44

Causes of non-essential HTN

aldosteronism
myxedema
hyperCa
pheo
steroid excess

45

how does epi/norepi produce neutrophilia

mobilization of neutrophils form vessel walls

46

how does epi/norepi produce hyperglycemia

activation of alpha 2 R on islet beta cells with decreased insulin output and icnreased liver glucose production by beta 2 R

47

how does epi/noreepi lead to hypotension

vasodilation Beta 2 R

48

pheo can cause hyperCa how

releases PTHrP

49

where are tumores that secrete norepi

anywhere in paraganglion chain

50

where are epinephrine tumors

adrenal gland

51

what is a good test for pheo

meta iodobenzylguanadine scintography because pheo takes it up

52

10% pheo

b/l 10%malignant

53

when must you investigate incidentalomas

25% incidence of having cancer cells if above 6cm so need biopsy if above this size

54

what is a preoperative evaluation for incidentaloma

plasam free metaneprhines
1 mg DXM suppression to rule out cushings (low dose DXM)

55

60% incidentalomas associated with

some degree of CAH

56

causes of facial flushing

carcinoid, medullary carcinoma of the thyroid
pheochromocytoma