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Flashcards in Endocrine - Adrenal Deck (20):
0

Cushing's syndrome versus Cushing's disease?

Hypercortisolism versus pituitary overproduction of ACTH

1

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

2

Best initial test for hypercortisolism? Also can use?

24 hour urine cortisol

Overnight dexamethasone suppression test

3

Causes of false positives on dexamethasone suppression test?

#Depression
#Alcoholism
#Obesity

4

Best initial tests to determine the source/location of hypercortisolism?

ACTH level

If elevated, do high dose dexamethasone test (Suppression indicates pituitary source, non-suppression indicates ectopic production)

5

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

6

Electrolyte and metabolic effects of hypercortisolism?

#Hyperglycemia
#hyperlipidemia
#Hypokalemia
#Metabolic alkalosis

7

CT shows unexpected incidentaloma on the adrenal gland – work up?

#Renin/aldosterone levels to exclude hyperaldosteronism (salt)
#Dexamethasone suppression test (sugar)
#DHEA-S (sex)
#Metanephrines (medulla)

8

Adrenal crisis versus Addison's disease?

Acute versus chronic hypoadrenalism

9

Addison's disease is most commonly caused by? Other classes?

Autoimmune destruction

#Infection (tuberculosis, histoplasmosis, coccidiosis)
#Adrenoleukodystrophy
#Metastatic cancer

10

Acute adrenal crisis is caused by?

#Surgery
#Hypertension
#sudden removal of chronic steroids

11

Presentation of acute/chronic hypoadrenalism?

Sign of chronic adrenal insufficiency?

#Altered mental status
#Anorexia, nausea/vomiting
#Hypotension

Hyperpigmentation

12

Lab findings in hypoadrenalism?

#Hypoglycemia
#Hyperkalemia
#metabolic acidosis
#Hyponatremia
#High BUN
#Eosinophilia

13

Most specific test of adrenal function?

Cosyntropin stimulation test

14

Management for acute adrenal crisis?

Treating adrenal crisis > finding etiology

#Hydrocortisone
#Fludrocortisone (mineralocorticoids) if postural instability

15

Most likely causes of primary hyperaldosteronism? And treatment?

Solitary adenoma (resection) >bilateral hyperplasia (spironolactone/eplerenone)

16

When to suspect secondary hypertension?

#Patient under 30 or over 60
#Hypertension not controlled by two antihypertensives
#low K (muscle weakness or diabetes insipidus)

17

Suspect primary hyperaldosteronism – best initial test? Most accurate test?

Renin/Aldosterone ratio

Venous blood sampling

18

MIBG scanning?

Nuclear isotope scan to locate pheochromocytoma originating outside of adrenal gland

19

Treatment for pheochromocytoma?

Phenoxybenzamine (alpha blocker). Then calcium channel blocker and beta blocker.

Eventfully surgery

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