Flashcards in Endocrine - Adrenal Deck (20):
Cushing's syndrome versus Cushing's disease?
Hypercortisolism versus pituitary overproduction of ACTH
Signs/Synptoms of Cushing's syndrome?
#Fat redistribution – moon face, truncal obesity, buffalo hump
#Skin – striae, easy bruising, thinning
#Bone – osteoporosis
#Hypertension (from increased sodium resorption and vasoconstriction)
#GU – menstrual disorders or erectile dysfunction
#renal – polyuria from hyperglycemia and increased Freewater clearance
Best initial test for hypercortisolism? Also can use?
24 hour urine cortisol
Overnight dexamethasone suppression test
Causes of false positives on dexamethasone suppression test?
Best initial tests to determine the source/location of hypercortisolism?
If elevated, do high dose dexamethasone test (Suppression indicates pituitary source, non-suppression indicates ectopic production)
Patient presents with signs of hypercortisolism. ACTH is elevated and does not suppress with high dose of dexamethasone – next step? If still unclear, perform? If that is negative?
MRI for pituitary lesion
Petrosal sinus sampling for elevated ACTH (for pituitary lesions too small to be detected by MRI)
CT Chest for masses
Electrolyte and metabolic effects of hypercortisolism?
CT shows unexpected incidentaloma on the adrenal gland – work up?
#Renin/aldosterone levels to exclude hyperaldosteronism (salt)
#Dexamethasone suppression test (sugar)
Adrenal crisis versus Addison's disease?
Acute versus chronic hypoadrenalism
Addison's disease is most commonly caused by? Other classes?
#Infection (tuberculosis, histoplasmosis, coccidiosis)
Acute adrenal crisis is caused by?
#sudden removal of chronic steroids
Presentation of acute/chronic hypoadrenalism?
Sign of chronic adrenal insufficiency?
#Altered mental status
Lab findings in hypoadrenalism?
Most specific test of adrenal function?
Cosyntropin stimulation test
Management for acute adrenal crisis?
Treating adrenal crisis > finding etiology
#Fludrocortisone (mineralocorticoids) if postural instability
Most likely causes of primary hyperaldosteronism? And treatment?
Solitary adenoma (resection) >bilateral hyperplasia (spironolactone/eplerenone)
When to suspect secondary hypertension?
#Patient under 30 or over 60
#Hypertension not controlled by two antihypertensives
#low K (muscle weakness or diabetes insipidus)
Suspect primary hyperaldosteronism – best initial test? Most accurate test?
Venous blood sampling
Nuclear isotope scan to locate pheochromocytoma originating outside of adrenal gland