Endocrine Function III Part 2 Flashcards Preview

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Flashcards in Endocrine Function III Part 2 Deck (37):
0

Addison's disease
-clinical symptoms due to glucocorticoid deficiency

Fatigue, weakness, weight loss, GI disturbances, post parandial hypoglycemiaz

1

Addison's disease
-clinical symptoms due to mineralcorticoid deficiency

Dehydration, hypotension, hyperkalemia, metabolic acidosis, hyponatremia

2

Addison's disease
-reason for hyperpigmentation and infertility

No negative feedback on anterior pituitary (ex hyperpigmentation not present because ACTH excess is not present to stimulate MSH production)

3

Addison's disease
-typical Na, K, blood sugar, cortisol, and ACTH lab results

Increased ACTH, decreased cortisol, decreased blood sugar, decreased sodium, and increased potassium

4

Cause of addisonian crisis?

During infection or acute stress, Addison's patient cannot respond with increased aldosterone and cortisol and can go into shock with hypotension, fever, hypovolemia, and hyperkalemia (life threatening)

5

What is the cause of Waterhouse-Friderichsen?

Caused by meningococcal meningitis and septicemia; this causes acute adrenal insufficiency

6

What is the most common cause of tertiary adrenal insufficiency ?

Chronic pharmacological administration of glucocorticoids

7

What are four conditions associated with a hyperfunctioning adrenal cortex?

1 primary aldosteronism (Conn's Syndrome)
2 secondary aldosteronism
3 cushing's syndrome
4 Congenital adrenal hyperplasia

8

Primary Aldosteronism (Conn's Syndrome)
-cause

Adenoma in outermost layer (tumors)

9

Primary Aldosteronism (Conn's Syndrome)
-outstanding clinical symptom

Hypertension

10

Primary Aldosteronism (Conn's Syndrome)
-typical serum and urine K,Na,aldosterone, and renin levels

Decreased Potassium, increased sodium, increased aldosterone, decreased renin, increased urine potassium, metabolic alkalosis caused by increased H secretion in urine (caused by increased Na reabsorption)

11

What are two general causes in secondary aldosteronism?

1 decreased blood flow to kidney causing decreased GFR
2 hyperactivity of RAAS causing increase in renin production

12

Cushing's Syndrome
-five clinical symptoms

Moon face, buffalo hump, truncal obesity, purple striae, hypertension

13

Cushing's Syndrome
-three general causes

Exogenous glucocorticoid therapy (prednisone), ACTH-dependent syndrome, ACTH-independent

14

Cushing's syndrome
-two specific causes of ACTH-dependent cushing's

Cushing's, Ectopic ACTH secreting tumors

15

Cushing's Syndrome
-Two specific causes of ACTH-independent cushing's

Adrenal adenoma, nodular adrenal hyperplasia

16

Cushing's syndrome
-two recommended screening tests and typical results if patient has syndrome

-24 hr free cortisol (>120=cushing's)
-overnight dexamethasone suppression test
-AM/PM cortisol levels

17

Cushing's syndrome
-expected morning and afternoon cortisol levels

Increased in AM, decreases over the day normally (cushing's is increased all the time)

18

Cushing's syndrome
-typical sodium, potassium, blood sugar, cortisol

Increased Na, decreased K, increased blood sugar, and increased cortisol

19

Cushing's syndrome
-typical ACTH results in Cushing's syndrome, cushing's disease, and ectopic ACTH secreting tumors

Increased ACTH due to the adrenal cortex being stimulated

20

Congenital adrenal hyperplasia (CAH) (adrenogenital syndrome)
-pathogenesis

Caused by enzyme deficiencies in the pathways to produce the glucocorticoids and mineralocorticoids; no negative feedback since cortisol not produced and aldosterone is decreased

21

Congenital adrenal hyperplasia (CAH) (adrenogenital syndrome)
-two common enzyme deficiencies

21-hydroxylase and 11-beta-hydroxylase

22

Congenital adrenal hyperplasia (CAH) (adrenogenital syndrome)
-expected cortisol, ACTH, progesterone, DHEA, sodium, and potassium levels

Decreased cortisol, increased ACTH, increased progesterone, increased DHEA, decreased sodium, and increased potassium

23

Congenital adrenal hyperplasia (CAH) (adrenogenital syndrome)
-typical symptoms in boys and girls

Females: abnormalities of external genitalia at birth (cannot tell if male or female); hirsutism, infertility, breast atrophy
Males: appear normal at birth, but have sexual precocity (too much testosterone)
Both: acne, coarsening of voice, scalp recession early in life
Both:

24

Congenital adrenal hyperplasia (CAH) (adrenogenital syndrome)
-lab test included in newborn screen to check for this condition

17-hydroxyprogesterone

25

This is an enzyme kinetic assay used to measure angiotensin I produced from angiotensinogen by renin

Plasma renin activity test (PRA)

26

Stimulation tests are used to assess _________ hormonal states. (Hypo or hyperfunctioning)

Hypofunctioning

27

Suppression tests are used to assess _______ hormonal states (hypo or hyper)

Hyperfunctioning

28

ACTH stimulation test
-diagnostic use

Differentiate primary adrenal insufficiency (Addison's) from secondary (hypopituitarism)

29

ACTH stimulation test
-analyte measured

Cortisol

30

ACTH stimulation test
-expected normal response

Serum cortisol should double in 30 minutes

31

ACTH stimulation test
-results in Addison's disease

Little or no change in cortisol levels

32

ACTH stimulation test
-results in hypopituitarism

Increased levels of cortisol on successive days (2-3) of ACTH stimulation (delayed or "staircase" response)

33

Metyrapone Test
-principle

Selectively inhibits 11-beta-hydroxylase, so the conversion of 11-deoxycortisol to cortisol is inhibited, allowing unrestricted release of ACTH

34

Metyrapone Test
-diagnostic use

Differentiation of normal patients from secondary adrenal insufficiency (hypopituitarism); assesses pituitary ACTH reserve; basically to see how much ACTH the patient can produce)

35

Metyrapone Test
-expected normal response

Decreased cortisol, increased 11-deoxycortisol, and increased ACTH

36

Metyrapone Test
-results in hypopituitarism

Unchanged cortisol, 11-deoxycortisol, and ACTH levels