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Flashcards in Endocrine - Adrenal Deck (20)
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0
Q

Signs/Synptoms of Cushing’s syndrome?

A
#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
1
Q

Cushing’s syndrome versus Cushing’s disease?

A

Hypercortisolism versus pituitary overproduction of ACTH

2
Q

Best initial test for hypercortisolism? Also can use?

A

24 hour urine cortisol

Overnight dexamethasone suppression test

3
Q

Causes of false positives on dexamethasone suppression test?

A
#Depression
#Alcoholism
#Obesity
4
Q

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

A

ACTH level

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

5
Q

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?

A

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
Q

Electrolyte and metabolic effects of hypercortisolism?

A
#Hyperglycemia
#hyperlipidemia
#Hypokalemia
#Metabolic alkalosis
7
Q

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

A
#Renin/aldosterone levels to exclude hyperaldosteronism (salt)
#Dexamethasone suppression test (sugar)
#DHEA-S (sex)
#Metanephrines (medulla)
8
Q

Adrenal crisis versus Addison’s disease?

A

Acute versus chronic hypoadrenalism

9
Q

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

A

Autoimmune destruction

#Infection (tuberculosis, histoplasmosis, coccidiosis)
#Adrenoleukodystrophy
#Metastatic cancer
10
Q

Acute adrenal crisis is caused by?

A
#Surgery
#Hypertension
#sudden removal of chronic steroids
11
Q

Presentation of acute/chronic hypoadrenalism?

Sign of chronic adrenal insufficiency?

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

Hyperpigmentation

12
Q

Lab findings in hypoadrenalism?

A
#Hypoglycemia
#Hyperkalemia
#metabolic acidosis 
#Hyponatremia
#High BUN
#Eosinophilia
13
Q

Most specific test of adrenal function?

A

Cosyntropin stimulation test

14
Q

Management for acute adrenal crisis?

A

Treating adrenal crisis > finding etiology

#Hydrocortisone
#Fludrocortisone (mineralocorticoids) if postural instability
15
Q

Most likely causes of primary hyperaldosteronism? And treatment?

A

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

16
Q

When to suspect secondary hypertension?

A
#Patient under 30 or over 60
#Hypertension not controlled by two antihypertensives
#low K (muscle weakness or diabetes insipidus)
17
Q

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

A

Renin/Aldosterone ratio

Venous blood sampling

18
Q

MIBG scanning?

A

Nuclear isotope scan to locate pheochromocytoma originating outside of adrenal gland

19
Q

Treatment for pheochromocytoma?

A

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

Eventfully surgery

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