la endo Flashcards by Mai Wells

In response to low serum cortisol or stress…

the hypothalamus secretes corticotropin releasing factor (CRF)

How well did you know this?

Not at all

Perfectly

In response to CRF…

the pituitary releases adrenocorticotropic hormone (ACTH) and melanocyte releasing hormone

How well did you know this?

Not at all

Perfectly

In response to ACTH …

the adrenal glands secrete cortisol

How well did you know this?

Not at all

Perfectly

In response to elevated cortisol levels…

the hypothalamus decreases production of CRF

How well did you know this?

Not at all

Perfectly

Cortisol is produced by the ___ in a reaction to ___. Its main functions are to suppress ___ and increase available ___ by increasing ___ levels and promoting the breakdown of __ and ___. It also regulates ___

Cortisol is produced by the adrenal glands in a reaction to stress. Its main functions are to suppress the immune response and increase available energy by increasing** blood sugar** levels and promoting the breakdown of fat and protein. It also regulates electrolytes.

How well did you know this?

Not at all

Perfectly

Cushing’s syndrome = ____ cortisol production

Addison’s disease = ___ cortisol production

Cushing’s syndrome = excessive cortisol production

Addison’s disease = low cortisol production

How well did you know this?

Not at all

Perfectly

Cushing’s disease
Pituitary …
gender

Cushing’s disease

Pituitary adenoma with hypersecretion of ACTH stimulating cortisol production in the adrenals.
Women have a three times greater chance of having this than men.

How well did you know this?

Not at all

Perfectly

Cushing’s syndrome

3 causes

Adrenal tumor producing an increase in cortisol
Ectopic production of ACTH – most commonly a small cell lung cancer
Long term use of corticosteroids usually in treatment of another disease

How well did you know this?

Not at all

Perfectly

cushing’s disease vs syndrome

syndrome is caused by an outside source (outside)

disease is caused by an inside source (pituitary)

How well did you know this?

Not at all

Perfectly

most specific signs of cushings

moon facies, (acanthosis nigrans) pigmented striae more than 1 cm wide(thigh, breast, abdomen), buffalo hump, truncal obesity, hirsutism

How well did you know this?

Not at all

Perfectly

moon facies, (acanthosis nigrans) pigmented striae more than 1 cm wide(thigh, breast, abdomen), buffalo hump, truncal obesity, hirsutism

cushings syndrome

How well did you know this?

Not at all

Perfectly

cushings skin symptoms

poor wound healing
atrophy
acanthosis nigrans
thin extremities

How well did you know this?

Not at all

Perfectly

cushings disease

-glucose, K++, cortisol

hyperglycemia
Hypokalemia
Cortisol is elevated

How well did you know this?

Not at all

Perfectly

hyperglycemia
Hypokalemia
Cortisol is elevated

cushings disease

How well did you know this?

Not at all

Perfectly

ACTH (cushings)
elevated
low

ACTH
elevated – pituitary or ectopic adenoma
low – adrenal cortex problem

How well did you know this?

Not at all

Perfectly

cushings disease
MRI or
CT

MRI for pituitary tumor

CT for adrenalcortical or other tumors

How well did you know this?

Not at all

Perfectly

For Cushing’s disease (pituitary adenoma) tx

transsphenoidal resection

How well did you know this?

Not at all

Perfectly

1-metyrapone and ketoconazole
2-Parenteral octreotide

Cushings
– may suppress hypercortisolism.
-may suppress ACTH

How well did you know this?

Not at all

Perfectly

what may suppress ACTH

Parenteral octreotide

How well did you know this?

Not at all

Perfectly

Often patients treated for Cushing’s syndrome will go into ___ withdrawal, …

cortisol withdrawal, Addison’s disease, and require hydrocortisone or prednisone.

How well did you know this?

Not at all

Perfectly

adrenal cortex releases what 3 things

androgen/sex hormones, aldosterone, cortisol

How well did you know this?

Not at all

Perfectly

aldosterone 3 functions

regulates BP
retains Na
secretes K+

How well did you know this?

Not at all

Perfectly

cortisol functions (3)

increase blood glucose
breaks down fats/proteins/carbs
regulates electrolytes

How well did you know this?

Not at all

Perfectly

prognosis of cushings after succesful excision of a benign adrenal adenoma

95% chance of a 5 year survival

How well did you know this?

Not at all

Perfectly

% of recurrence over 10 years with cushings

15-20%

what % of addison's is secondary to autoimmune issues | - other 4 causes

80% Other causes include TB, genetic disorders, removal of adrenals, trauma(hemorrhaging)

addison's secondary causes are ...

pituitary based

calicification of adrenal glands

precipated by infection, trauma, surgery, stress, SUDDEN cessation of corticosteroid medications

adrenal crisis

nonspecific GI symptoms, hypoglycemia, weakness, myalgias, fatigue, lethargy, salt craving, mild hyponatremia

secondary adrenocortical insufficiency

Sparse axillary and pubic hair Hyperpigmentation of skin especially of creases or pressure areas (waistband/bra line) Hypotension typically systolic under 110 Salt craving AMENORRHEA

addison's

addison's symptoms

Sparse axillary and pubic hair Hyperpigmentation of skin especially of creases or pressure areas (waistband/bra line) Hypotension typically systolic under 110 mmhg AMENORRHEA Salt craving

addison's - menstuation - hair - reflexes - BP

- amenorrhea - sparse axillary and pubic hair - delayed DTR - low BP

hyperpigmentation in addison's

only in primary disease when ACTH is elevated

hypotension, acute abd or low back pain, vomiting, diarrhea, dehydration, altered mental status

addisonian crisis; can be fatal if untreated

Cosyntropin stimulation test or ACTH stimulation test

cosyntropin test is diagnostic; ACTH is injected and the plasma cortisol is then monitored for a reaction. - a serum cortisol rise of more than 18 after adminstration of cosyntropin is nml; anything less is suspicious

imaging of addison's

Chest x-ray for TB | Abdominal CT – small adrenal glands in an autoimmune disease

diagnostic (addison's) | - early plasma cortisol and ACTH

low cortisol(under 3) and elevated ACTH(over 200)

DHEA level of 1,000 | -produced where

- anything higher excludes Addison's | - adrenal gland

addison's tx

- Replacement with oral hydrocortisone 1st line. Dexmethasone.

Fludrocortisone

Has sodium retaining properties and is the treatment for Addison's.

addison's length of steroids

These are given for life and should be monitored by clinical symptoms as well as blood tests to assure proper dosing throughout the patient’s lifespan

addison's tx for improved well being, increased muscle mass, reversal of femoral neck bone loss

DHEA; monitor for androgenic effects

addisonian crisis tx

IV saline, glucose, glucocorticoids and tx of underlying disease

high fever low blood pressure confusion or coma hypoglycemia

adrenal crisis give IV saline, glucose, glucocorticoids

primary and secondary addison's differences

primary: assoc with increased skin pigmentation, decreased glucocorticoids and decreased mineralcorticoids secondary: ONLY assoc with decreased glucocorticoids and DOES NOT have skin pigmentation or hyperkalemia

1. cortisol 2. aldosterone 3. DHEA 4. ACTH

Most common etio for Addisons

autoimmune, think Hashimotos or DM type 1

autoimmune, Hashimotos or DM type 1

think Addisons

sudden d/c of exogenous steroid

secondary adrenal insufficiency and/or Addisonian crisis

"Stress Hormone"

cortisol

in treating a pt with chronic adrenal insufficiency, they must be given IV glucocorticoids and _______ before and after surgical procedures

IV isotonic fluids

inc ACTH: Cushing disease; dec ACTH; Cushing disease

acanthosis nigricans: Cushing's

chronic renal insuff

cushing

tx for cushing disease

transspenoidal resection

24 hr urinary free cortisol, nighttime salivary cortisol, low dose overnight dexmathasone suppression test most specific?

24 test. order 2 of these tests for cushings disease

hyperglycemia, leukocytosis, hypokalemia, metabolic alkalosis

Cushings disease

hyponatremia, hyperkalemia, hypoglycemia

Chr. adrenal insufficieny

hyponatremia is SIADH

chronic hyponatremia tx 1) rate 2) unresponsive to fluid restriction 3) euvolemic or hypervolemic hyponatremia

1) over 72 hr duration with \<8 mEq/L/day 2) demeclocycline 3) vasopressin antagonists(conivaptan)

SIADH

DI on left SIADH on right

chronic hyponatremia tx 1) rate 2) unresponsive to fluid restriction 3) euvolemic or hypervolemic hyponatremia

1) over 72 hr duration with \<8 mEq/L/day 2) demeclocycline 3) vasopressin antagonists(conivaptan)

labs in volume depletion

hemocrit and serum albumin increased urinary sodium decreases urea increases (secondary to urine stasis in nephron) but little change in serum Cr

primary hyperaldosteronism

Most common cause of primary hyperaldosteronism

adrenal hyperplasia: hyperfunctioning adrenal releasing lots of aldosterone

describe secondary hyperaldosteronism

increase RAAS activity, increase renin and this leads to increase in aldosterone

HTN, HYPOkalemia, metabolic alkalosis

triad of hyperaldosteronism

Primary _____ is a cause of secondary HTN

hyperaldosteronism

polyuria, fatigue, prox muscle weakness, decreased DTR, hypomagnesemia, constipation

hypokalemia

pt develops HTN at extreme age, not controlled on 3 meds

primary hyperaldosteronism

what test to dx hyperaldosteronism

renin and aldosterone levels. both high: secondary aldosterone high and renin low: primary. maybe do a adrenal supp test

hypo on left. hyper on right do labs later.

hyperthyroidism

hyperthyroidism definitive tx

radioactive thyroid ablation or total thyroidectomy | - give levothyroxine (oral T4) and steroids

avoid aspirin! Iv fluids, propanolol, PPU and IV glucocorticoids.

increased aldosterone and decreased renin

primary hyperaldosteronism

MC etio of primary hyperaldosteronism

bilateral adrenal hyperplasia

increased aldosterone and renin

secondary hyperaldosteronism

Conn syndrome

aldosteronoma

findings with hyperaldosteronism

secondary HTN hypernatremia hypokalemia metabolic alkalosis

hyperaldosteronism

aldosterone function?

excretes K+ and H+, holds onto Na; interacts with angiotensin 11

testing for hyperaldosteronism

get both renin and aldosterone levels nml ratio: secondary cause (pituitary) If aldosterone high and renin low: primary (renal cortex)

aldosterone is part of which zona layer

glomerulosa (outer layer)

cortisol is part of which zona layer

fasciculata (middle layer)

cortisol functions

increases blood glucose, osteoclasts, increases BP, helps fight infections

decrease in ADH does what to fluid what about increase

decrease causes excretion of fluid, diluted urine, and more water excreted (polyuria) increase causes more retention of fluid, diluted blood, and more water retained.

zona reticularis is which layer and secretes what

inner layer, DHEA/androgens