Endocrine pt 2 highlights Flashcards
(34 cards)
What are the 2 main types of pituitary adenomas? List important Sx of each
1) Hormone secreting = “functional”
-hormone excess Sx, small
2) Non-hormone secreting = “hypofunctioning”
-structural Sx i.e. from compression of optic chiasm like Bitemporal hemianopsia
What if a pt with a pituitary adenoma can’t get surgery? List the 2 options and which is not optimal
1) Cabergoline
2) Radiation; not optimal
GH tumor:
1) If hypersecreting tumor occurs _______ puberty, pt will be tall, and proportionally developed.
2) This is called what?
1) before
2) Gigantism
GH tumor:
1) If hypersecreting tumor occurs _________ puberty, the epiphysial plates will be closed and pt will have bone growth without elongation
2) What is this called?
1) after
2) Acromegaly
______________ or ____________ is first line Tx for GH tumors
Octreotide or Lanreotide
Hypothalamus > corticotropin releasing hormone > corticotropes release > adrenocorticotropic hormone > fasciculata releases _________
cortisol
What are 3 main effects of hypercortisolism?
1) HTN
2) DM
3) Obesity
What are the 2 main tests for hypercortisolism?
1) Late night cortisol check
2) 24-hour urine is most specific
So, the cortisol is high on one of the two main tests; now what?
Give low-dose dexamethasone suppression test
Low-dose dexamethasone suppression test: If there is not suppression of _______, they have an illness of hypercortisolism
cortisol
Giving low dose dexamethasone should suppress the __________________ and _________________
hypothalamus and anterior pituitary
So, the low-dose test didn’t suppress cortisol. Now what?
Check ACTH
So, the low-dose test didn’t suppress cortisol. Now you check ACTH, and it’s low. What does the pt have?
Pituitary adenoma
So, the low-dose test didn’t suppress cortisol. Now you check ACTH, and it’s high. What does the pt have?
Pituitary adenoma or Paraneoplastic disease
So, the ACTH remains high after dexamethasone suppression, now what?
1) The endocrine axis will respond to a high enough dose of counterregulatory hormone.
2) This means that a high-dose dexamethasone suppression test will cause a drop in ACTH if the source is a pituitary adenoma
Primary hypercortisolism:
1) This is a pt with what?
2) Why is there consistent negative feedback decreasing CRH and ACTH?
3) Because ACTH is therefore low, the remaining adrenal tissue ____________ due to lack of stimulation
1) Adrenal tumor
2) Cortisol is always high
3) atrophies
Secondary Hypercortisolism (ACTH dependent illness):
1) Whether from pituitary adenoma or malignancy, this patient will have very _______ levels of ACTH
2) Because ACTH is always ________, the adrenal glands will ___________ and melanocytes will be stimulated and will demonstrate ___________________.
3) What should you image?
1) high
2) high; hyperatrophy; hyperpigmentation
3) Image the lungs to evaluate tumor confirmed with biopsy
slide 39
This is why patients on long term steroids need to be tapered
Aldo and cortisol will both be low with what condition?
Primary adrenal insuff (Addison’s disease)
Primary adrenal insufficiency = ________ glands not working
Adrenal
Primary adrenal insufficiency: What 2 values are low?
Low cortisol, low aldosterone
Primary adrenal insufficiency: What are the 2 main types?
Chronic = Addison’s disease
Acute = almost dead (Addison’s crisis)
Dx of chronic HypOcortisolism / HypOaldosteronism:
1) What is one thing you’ll see on CMP?
2) What will you know if if insufficient or absent rise in serum cortisol after ACTH administration?
1) Hyperkalemia
2) Adrenal insufficiency
HypOcortisolism / HypOaldosteronism:
1) How to Tx chronic?
2) How to Tx acute?
1) Glucocorticoid replacement: hydrocortisone
Mineralocorticoid replacement: fludrocortisone
2) High dose hydrocortisone!
