Endocrine: Adrenal Disorders Flashcards by Anthony Carli

High ACTH, High Cortisol indicates…

80% of cases

Cushings disease (ACTH hypersection)&raquo_space;> non-pituitary tumor (ACTH dependent)

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ACTH Low, Cortisol High indicates…

20% of cases

Iatrogenic/factitious Cushings Syndrome (excess exogenous GC)

malignancy (ACTH independent)

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Gold standard dx for cushings…

24 Hour Urinary Free Cortisol Excretion = Gold Standard

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4 imaging modalities to evaluate cushings…

MRI (r/o pituitary tumor)

CXR (r/o lung mass)

Pelvic US (r/o ovarian mass)

CT abdomen (r/o adrenal tumor)

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Besides 24 hour urinary free cortisol excretion, what two labs can be used to dx cushings?

Late-Night Salivary Cortisol

Low-Dose Dexamethasone Suppression Test

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A Low-Dose Dexamethasone Suppression Test: Cortisol > ______ mcg/dL =

5mcg/dL

abnormal, ACTH-independent

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What is the protocol for low-dose dexamethasone suppression test?

measure baseline 8am cortisol

administer 1 mg dexamethasone at 11pm

measure serum cortisol 8 am next day

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What is the 1st line tx for cushings absent a specific etiology?

Ketoconazole (1st Line), +/- Metyrapone, Mitotane (medical adrenalectomy)

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1st line for cushings due to Exogenous CS

taper to lowest therapeutic dose

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1st line for cushings due to Pituitary Adenoma

transsphenoidal resection

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1st line for cushings due to Adrenal Tumor

adrenalectomy

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1st line for cushings due to …
Adrenal hyperplasia
inoperable tumor
other malignancy

Ketoconazole (1st Line) +/- Metyrapone, Mitotane (used for medical adrenalectomy)

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A patient presents with…

amenorrhea
Striae, Hyperpigmentation
Moon Face &amp; Buffalo Hump
HTN
Osteoporosis

Cushings

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Hyperaldosterone has what effect on potassium?

↓ Serum K+

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Bilateral Idiopathic Adrenal Hyperplasia is the most common cause of…

Conn’s Syndrome/Primary Hyperaldosteronism

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30% of cases of Conn’s Syndrome/Primary Hyperaldosteronism are caused by…

unilateral aldosterone-producing adenoma

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a patient presents with…

HTN
Hypokalemia
weakness
paresthesia
HA
polyuria
polydipsia

Conn’s Syndrome/Primary Hyperaldosteronism

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3 labs to dx Conn’s Syndrome/Primary Hyperaldosteronism

↑ Plasma Aldosterone Concentration (PAC)

↓Plasma Renin Activity (PRA)/Plasma Renin Concentration (PRC)

Spontaneous Hypokalemia

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Who should be tested for Conn’s Syndrome/Primary Hyperaldosteronism

HTN + Comorbidities

FHx

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What imaging can assess for

Conn’s Syndrome/Primary Hyperaldosteronism?

CT Abdomen

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Conn’s Syndrome/Primary Hyperaldosteronism caused by Unilateral Adrenal Adenoma is treated how?

surgery

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Conn’s Syndrome/Primary Hyperaldosteronism caused by Bilateral Idiopathic Adrenal Hyperplasia is treated how?

Spironolactone + antihypertensives

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Conn’s Syndrome/Primary Hyperaldosteronism being treated medically should include monitoring of (3) during the 1st 4-6 weeks…

Study These Flashcards

K+, Cr, BP

↓ synth of all adrenocortical hormones

Study These Flashcards

Addison’s Disease/Primary Adrenocortical Insufficiency

The below indicates... ↓ Cortisol, ↓ Aldosterone, ↓ Androgens ↑ ACTH, ↑ CRH

Addison’s Disease/Primary Adrenocortical Insufficiency

What is the MC cause of addison's?

Autoimmune Destruction of Adrenal Cortex

The below presentation is concerning for... Hyperpigmentation salt craving postural hypotension

Addison's/primary adrenocortical insufficiency

What are 2 diagnostics for addison's/primary adrenocortical insufficiency?

Serum AM Cortisol Cosyntropin (ACTH) Stimulation Test

These labs are helpful adjuncts for diagnosing... ACTH, Renin, Aldosterone, Anti-Adrenal Abs, CMP, CBC

addison's/primary adrenocortical insufficiency

What is the protocol for Cosyntropin (ACTH) Stimulation Test

draw baseline cortisol administer bolus of cosyntropin repeat cortisol q 30 min and 60 min

With Cosyntropin Stimulation Test, Abnormal Result is Cortisol fails to increase by _____ above baseline, or to _____

increase 7 mg/dL or to > 18 mcg/dL

Three treatment options for addison's?

hydrocortisone BID/TID OR Dexamethasone/predisone OR Fludrocortisone +/- DHEA (women)

The presentation of Secondary/Tertiary Adrenocortical Insufficiency lacks what two addison's signs/sxs?

Normal aldo, no hyperpigmentation

The below indicates... ↓ Cortisol, ↓ Androgens, ↓ ACTH Normal Aldo ↑ CRH

Secondary adrenocortical insufficiency

The below indicates... ↓ Cortisol, ↓ Androgens, ↓ ACTH, ↓ CRH Normal Aldo.

Tertiary

What is the MC cause of secondary/tertiary adrenocortical insufficiency?

Exogenous Steroid Use

What is a most commonly benign tumor arising from the chromaffin cells in the adrenal medulla

pheochromocytoma

A patient with the below S/S is concerning for... Episodic HA, Tachycardia, Sweating + paroxysmal HTN

Pheo

The below can be found in... Abdominal mass adrenal mass MEN2 neurofibromatosis

pheo

Three diagnostic tests used in pheo...

Plasma Metanephrines 24-hr Urine (Catecholamines, Metanephrines, VMA) Clonidine Suppression Test

What result of Clonidine Suppression Test is abnormal?

no reduction of catecholamines after clonidine admin.

What labs may serve as an adjunct to pheo dx? (4)

Thyroid Function Tests Plasma/Urine Catecholamines Plasma Epi/NE

What imaging is helpful in dx pheo?

non contrast CT abd.

What is the progression of tx for pheo?

Chemical Sympathectomy → Surgical Excision/Adrenalectomy (definitive tx)

Low cortisol, low ACTH + exaggerated and prolonged ACTH response on CRH stimulation test

tertiary adrenal insufficiency | steroid use, hypothalamus

Low cortisol, low ACTH + absent/subnormal ACTH response on CRH stimulation

secondary adrenal insufficiency | steroid use, pituitary

What drugs are used as "chemical sympathectomy"?

Phenoxybenzamine: pure alpha blocker Propranolol

adrenal mass > 1cm incidentally found

adrenal incidentaloma

What are two important questions to answer with adrenal incidentaloma?

is it functioning? | is it malignant?

What must be ruled out in all cases of adrenal incidentaloma?

pheo, subclinical cushings

If adrenal incidentaloma + HTN, r/o...

primary hyperaldosteronism

If adrenal incidentaloma + known malignancy elsewhere...

no biopsy

If negative workup and adrenal incidentaloma is < 2 cm how often should imaging and dexamethasone suppresson be repeated?

imaging q 6 mo dexamethasone suppression q annually x 4 years

If negative workup and adrenal incidentaloma is 2+ cm, what should be considered?

surgical resection

This test is for... low dose dexamethasone suppression test

cushings

This test is for... cosyntropin stimulation test

addison's

This test is for... clonidine suppression test

pheo

Endocrine: Adrenal Disorders Flashcards

(57 cards)