Endocrine Error List Flashcards
(38 cards)
What is Cushings Disease
High Cortisol caused by excess ACTH secretion
What is Cushings Syndrome
Sigs and sx related to Cortisol excess
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
Dx of Cushings Disease (1st step)
Test to see that you have elevated Cortisol
24 hour urine Salivary
Low Dose Dexamethasone
What do the results of the Low Dose Dexamethasone tell you
The normal response is Cortisol Suppression
No Suppression = Cushings Syndrome
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
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)
Tx of Cushing’s Disease
Transphenoidal Surugery
Tx of Cushings due to Ectopic or Adrenal Tumor
Remove Tumor
Tx of Cushings if due to exogenous cause (like excess steroid use)
Withdraw GRADUALLY to avoid Addison Crisis
What is Primary Alodsteronism
Increased aldosterone that is INDEPENDENT from Renin
What is the role of Aldosterone
Retains water and salt
Works via RAAS and responds to Renin production
What is Conn Syndrome
An Adrenal Aldosteronoma
Sx of Primary Aldosteronism
Hypokalemia: Proximal muscle weakness, polyuria, fatigue
Hypertension: Headaches, Diastolic BP tends to be more elevated than Systolic
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
Tx of Primary Aldosteronism
Conn Syndrome: Remove Adrenal Aldosteronoma + Spironolactone
Hyperplasia: Spironolactone, Ace-I, CCB
What is Diabetes Insipidus
Either no ADH or no response to ADH
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
What drug is the most common cause of Nephrogenic Diabetes Insipidus
Lithium
Sx of Diabetes Insipidus
Polyuria, Polydipsia, Hypernateremia if severe
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
Tx of Diabetes Insipidus
Central: Desmopressin, Carbamazepine
Nephrogenic: Sodium/Protein Restriction, Hydrochlorothiazide, Indomethacin (NSAID)
What is Hypothyroidism
No T3/T4 = Slow Sluggish
What is T3/T4 used for
Metabolism
Low T3/T3 = Slow Sluggish
High T3/T4 = Excited
