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Flashcards in Endocrine Error List Deck (38):
1

What is Cushings Disease

High Cortisol caused by excess ACTH secretion

2

What is Cushings Syndrome

Sigs and sx related to Cortisol excess

3

Sx of Cushings Disease

Central Trunk Obesity
Moon Facies
Buffallo Hump
Supraclavicular Fat Pads
Wasting Extremities
Striae
HTN
Weight Gain
Osteoporosis, Hypokalemia, Acanthosis Nigricans, Hirtuism

4

Dx of Cushings Disease (1st step)

Test to see that you have elevated Cortisol
24 hour urine Salivary
Low Dose Dexamethasone

5

What do the results of the Low Dose Dexamethasone tell you

The normal response is Cortisol Suppression
No Suppression = Cushings Syndrome

6

Dx of Cushings Disease (2nd Step)

Measure ACTH
If elevated ACTH: Dependent
If Normal or Reduced: Independent
If Independent it means the adrenal glands are going crazy (adrenal tumor), so scan the adrenals and take out the tumor
If Dependent it means Cortisol is being secreted as a response to high ACTH. Now you need to figure out where it's coming from. Could be Pituitary tumor or Ectopic Tumor

7

Dx of Cushing's Disease (3rd Step - Where is high ACTH coming from)

High Dose Dexamethasone
If Cortisol is suppressed it means excess ACTH is coming from a Pituitary Tumor (adrenal glands are responding normally to suppression)
If Cortisol is NOT suppressed, it means ACTH is coming from an ectopic location (mutated cells)

8

Tx of Cushing's Disease

Transphenoidal Surugery

9

Tx of Cushings due to Ectopic or Adrenal Tumor

Remove Tumor

10

Tx of Cushings if due to exogenous cause (like excess steroid use)

Withdraw GRADUALLY to avoid Addison Crisis

11

What is Primary Alodsteronism

Increased aldosterone that is INDEPENDENT from Renin

12

What is the role of Aldosterone

Retains water and salt
Works via RAAS and responds to Renin production

13

What is Conn Syndrome

An Adrenal Aldosteronoma

14

Sx of Primary Aldosteronism

Hypokalemia: Proximal muscle weakness, polyuria, fatigue
Hypertension: Headaches, Diastolic BP tends to be more elevated than Systolic

15

Dx of Primary Aldosteronism

Hypokalemia with metabolic Alkalosis
Aldosterone:Renin Ration Screening
If ARR >20 and plasma Aldosterone >20 and low plasma renin levels = Primary

16

Tx of Primary Aldosteronism

Conn Syndrome: Remove Adrenal Aldosteronoma + Spironolactone
Hyperplasia: Spironolactone, Ace-I, CCB

17

What is Diabetes Insipidus

Either no ADH or no response to ADH

18

What are the 2 causes for Diabetes Insipidus

Central: Not enough ADH secreted
Nephrogenic: Something is wrong with the kidney's in not sensing ADH

19

What drug is the most common cause of Nephrogenic Diabetes Insipidus

Lithium

20

Sx of Diabetes Insipidus

Polyuria, Polydipsia, Hypernateremia if severe

21

Dx of Diabetes Insipidus

Clinical
Fluid Deprivation Test Establishes DI. Normal response will be to concentrate urine. If urine continues to be diluted, you have DI
Desmopressin stimulation establishes cause. Concentrated urine or reduced urine output = Central (kidneys respond appropriately to ADH)
Dilute urine and continued large volumes = Nephrogenic

22

Tx of Diabetes Insipidus

Central: Desmopressin, Carbamazepine
Nephrogenic: Sodium/Protein Restriction, Hydrochlorothiazide, Indomethacin (NSAID)

23

What is Hypothyroidism

No T3/T4 = Slow Sluggish

24

What is T3/T4 used for

Metabolism
Low T3/T3 = Slow Sluggish
High T3/T4 = Excited

25

What is the most common cause of Hypothyroidism in the United States

Hashimoto (Autoimmune)

26

What is the most common cause of Hypothyroidism in the World

Iodine Deficiency

27

What is De Quervain's and tx

A viral infection that leads to a PAINFUL thyroid (no autoantibodies)
Tx: ASA for pain and inflammation

28

What is Acute Thyroiditis and tx

A bacterial infection that causes painful and fluctuant thyroid
Tx: Abx, drainage if abscess present

29

What are sx of Hypothyroidism

Fatigue, Slow, Weight Gain, Cold Intolerant, Pale, Cool, Dry, Coarse Hair, Constipation, Periorbital Edema, Bradycardia, Decreased CO, slow DTR

30

Dx of Hypothyroidism

High TSH, Low T3/T4
Positive thyroid antibodies present in Hashimotos

31

Tx of Hypothyroidism

Levothyroxine (T4)
Iodine

32

What is a Pheochromocytoma

A Catecholamine-Secreting adrenal tumor
Secretes Norepinephrine and Epinephrine autonomously and intermittently

33

Sx of Pheochromocotyoma

HTN, Palpitations, Headaches, Excess Sweating

34

Dx of Pheochromoctyoma

Increased 24 hour urinary catecholamines including metabolites (Metanephrine and Vanillylmandelic Acid)
MRI or CT of abdomen to visual Adrenal Tumor

35

Tx of Pheochromocytoma

Complete Adrenalectomy
Need to give Alpha-Blockers before surgery
(Phenyoxybenzamine or Phentolamine) for 7-14 days followed by Beta Blockers

36

Why do you need to give Alpha blockers before surgery for pheochromocytoma

When you do surgery, you're going to aggravate the tumor and release catecholamines, this is going to cause a spike in BP which can be life-threatening in surgery

37

What are the 4 types of Thyroid Cancers. Which one is better/worse/least/most aggressive

Papillary: Least Aggressive
Follicular: More Aggressive, good prognosis
Medullary: Low Cure Rate
Anaplastic: Most Aggressive, Rapid Growth, Poor Prognosis

38

Tx for Thyroid Cancers

Papillary: Thyroidectomy
Follicular: Thyroidectomy
Medullary: Thyroidectomy, Calcitonin
Anaplastic: Chemo, Radiation

If you remove the thyroid you'll need to give Levothyroxine for life