Endocrine #1 Flashcards
(51 cards)
Chronic Adrenocortical Insufficiency is due to _________
Pituitary failure of ACTH secretion
Causes of adrenocortical insufficiency
-History of exogenous glucocorticoid use
Symptoms of Primary Adrenocortical Insuffiency (Addison’s Disease)
-Due to lack of sex hormone and aldosterone
- Hyperpigmentation, orthostatic hypotension
- Amenorrhea, loss of libido, loss of pubic/axillary hair
Baseline labs for adrenocortical insufficiency
- Elevated ACTH (Primary), Decreased ACTH (Secondary)
- Hypoglycemia
- Hyperkalemia
Explain the high-dose ACTH Cosyntropin Stimulation Test
Adrenal insufficiency if insufficient or absent rise in serum cortisol (< 18) after ACTH administration
Treatment for adrenocortical insufficiency
- Glucocorticoid Replacement: Hydrocortisone
- Mineralocorticoid Replacement: Fludricortisone (In Addison’s, may be added)
Treatment for Addison’s Disease
- Isotonic fluids (normal saline or D5N5) + IV Hydrocortisone or Dexamethasone
- Fludricortisone to reverse electrolyte disorders
What is Cushing’s Syndrome?
Signs and symptoms related to Cortisol excess
4 main causes of Cushing’s
- Long-term high-dose glucocorticoid therapy (MC)
- Pituitary gland ACTH overproduction (MC endogenous cause)
- Ectopic ACTH-producing tumor (small cell lung cancer)
- Adrenal Tumor/Adenoma
Symptoms of Cushing’s
- Weight gain, obesity
- Moon facies
- Buffalo Hump
- Supraclavicular Fat Pads
- Thin Extremities
- Striae
- Acanthosis Nigricans
- Hypertension
- Hirsuitism oily skin
Screening tests for Cushing’s
- 24 hour urinary free cortisol (most specific)
- Nighttime salivary cortisol
- Low-dose overnight Dexamethasone suppression test
What is the test that helps differentiate Cushing’s from other causes of cortisol excess?
- Baseline ACTH + Dexamethasone suppression test
- –Increased ACTH + suppression of cortisol on high dose = Cushing’s
Treatment of Cushing’s Disease
- Corticosteroid use: Gradual taper
- Transsphenoidal Resection
Primary hyperaldosteronism is a cause of _______
Secondary hypertension
Triad of symptoms for primary hyperaldosteronism
-Hypertension, Metabolic Alkalosis, Hypokalemia
Labs for hyperaldosteronism
- Plasma renin and aldosterone levels: aldosterone to renin ratio: ARR > 20:1
- Hypokalemia
- Metabolic Alkalosis
What is a confirmatory test for primary hyperaldosteronism?
oral sodium loading test: high urine aldosterone
what are some symptoms of hypokalemia?
Proximal muscle weakness, polyuria, fatigue, constipation, decreased DTRs
Treatment for primary aldosteronism
-Spironolactone, ACE inhibitors
A Pheochromocytoma is a ______ secreting tumor
Catecholamine
Pathophysiology of a Pheochromocytoma
-Secretes norepinephrine, epinephrine, and dopamine autonomously and intermittently
Symptoms of a Pheochromocytoma
-Hypertension
PHE
- Palpitations
- Headache
- Excessive Sweating
Confirmatory test for Pheochromocytoma
-24 hour urinary fractionated catecholamines including metabolites (increased metanephrines and vanillylmandelic acid)
Treatment for Pheochromocytoma
- Nonselective alpha blockade: Phenoxybenzamine or Phentolamine 1-2 weeks followed by BB
- Complete adrenalectomy after 1-2 weeks of medications
