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Setha: Endocrine > Quick tidbits from lecture > Flashcards

Quick tidbits from lecture Flashcards

1
Q

Secretion localized to outer layer or adrenal cortex

Regulated by renin secretion of kidneys

A

Aldosterone

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2
Q

Has mineralcorticoid effects on renal tubulues

Na, K regulation

A

Aldosterone

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3
Q

Major glucocorticoid secreted by middle and inner adrenal cortex

A

Cortisol

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4
Q

Secretion regulted by ACTH release from putuitary

necessary for life

A

Cortisol

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5
Q

Inhibits insulin secretion

Increases hepatic gluconeogenesis

Decreases protein stores (decrease synthesis and increase catabolism)

Dampens defense mechanisms

Inhibits production or action of many mediators of inflammation

Required for production of Angiotension II

Lowers serum Ca (Kidney and GI)

Necessary for normal bodily function

A

Functions of cortisol

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6
Q

What is cortisol secreted in respone to?

A

stress, trauma, infection and major surgery

Major role in supporting normal circulatory function and hemodynamic stability

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7
Q

Clinical syndrome/disease resulting from excessive systemic corticosteroids

A

Cushings Syndrome/Disease

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8
Q

2 sources of Cushings

A

Endogenous overproduction: tumors secreting cortisol or ACTH

Exogenous: glucocorticoid administration- superphysiologic doses over prolonged time

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9
Q

Adrenal adenoma or carcinoma that secretes excessive cortisol leading to supression of ACTH due to negative feedback

Non-pituitary neoplasm (Lung Ca) producing excessive, ectopic ACTH

What do these cause?

A

Cushing’s Syndrome

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10
Q

What is the most common cause of Cushins syndrome?

A

Exogenous: prolonged administation of synthetic, glucocorticoids in supraphysiologic doses

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11
Q

Pituitary adenoma secreting excessive ACTH causes what?

A

Cushing’s disease

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12
Q

Central obesity

Moon face

Abdominal protuberance

Buffalo hump

Thin skin with easy bruising/striae

Thin extremeties/muscle wasting

Acne/hirsutism

A

Cushing’s

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13
Q

What are some big systemic disruptions that can be seen with Cushings?

A

Glucose intolerance/DM

HTN

Osteopenia and osteoprosis

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14
Q

Lab findings with Cushings

A

Hyperglycemia, glycosuria, leukocytosis

Elevated cortisol levels with loss of diurnal pattern

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15
Q

What test should be given with suspected Cushings and what are the results?

A

Dexamethasone supression test: 1mg given at 11PM

AM coritsol should be low (<5ug/dL)

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16
Q

What test should be given with Dexamethone suppression test for Cushings?

A

24 hour urine free cortisol/creatine

>95ug cortisol/gram creatinine confirms hypercorticolism

17
Q

Complications of Cushings if left untreated?

A

Significant morbidity from diabetes, HTN, osteoporosis

Susceptible to infections

Compression/patholopgic fractures

Femoral neck aseptic necrosis

18
Q

Autoimmune destruction of adrenal cortex that can develop over time resulting in chronic deficiency of cortisol, aldosterone, and adrenal androgens

A

Addison’s Disease

19
Q

Transphenoidal resection of pituitary adenoma

Laproscopic resection of adrenal tumors

Post op- Rx with Cortisol

A

Treatment for Cushings

20
Q

Which glucocorticoid is most popular in causing Cushings?

A

Prednisone

21
Q

What must you do when discontinuing glucocorticoids to prevent chronic supression of adrenal glands?

A

TAPER

22
Q

Fatigue, weakness, and hypotension that doesn’t respond to fluids or pressor drugs

A

Adrenal insufficiency

23
Q

Who is at risk for getting Adrenal insufficiency?

A

People taking exogenous corticosteroids especially if requirement for cortisol increases dyuring stress, trauma, MI or surgery or if the glucocorticoid is tapered too rapidly and adrenal gland can’t resume normal secretion

24
Q

Labs for adrenal insufficiency

A

Neutropenia, lymphocytosis, eosinophilia, hyperkalemia, hyponatremia, hypoglycemia

low AM cortisol level

25
Q

Small non-calcified adrenals on Abdominal CT

A

Addison’s Disease

26
Q

What test is used to test adrenal insufficiency?

A

Cosyntropin stimulation test

27
Q

What is the Cosyntropin stimulation test measuring?

A

Measure of adrenal reserve of cortisol

28
Q

Sx non-specific (eg weakness, fatigue, weight loss, myalgias, N/V/D, abdominal pain, anxiety, etc)

Low BP, orthostasis, hyperpigmentation of skin (esp knuckles, palmar creases, elbows, knees, nipples, nailbeds) and reduction of axillary and pubic hair

A

Addison’s Disease

29
Q

How is the Cosyntropin test carried out?

A

IV/IM cosyntropin 250ug (synthetic ACTH) given

Serum cortisol obtained in 30-60 mins

Normal response: rise in serum cortisol at least 20ug/dL

30
Q

Glucocorticoid replacement following diurnal pattern

(Hydrocortisone 15-20mg in AM and 5-10-10mg in PM)

A

Treatment for chronic adrenal insufficiency

31
Q

What must you do for treatment with chronic adrenal insufficiency during periods of stress?

A

Must increase maintenance dose 8-10x to reduce acute adrenal insufficiency/crisis

32
Q

Life threatening medical emergency most often seen in patients with suppressed adrenal gland who developed need for increased cortisol in time fo stress

A

Acute Adrenal Insufficiency

33
Q

Hypotension/shock that is unresponsive to IV fluids/pressors

A

Acute adrenal insufficiency/crisis

34
Q

Treatment of acute adrenal insufficiency/crisis?

A

Rapid infusion of isotonic fluids

IV hyrocortisone

Tx underlying physiologic stress

Oral Hydrocortisone once stable

35
Q

Rare cause of secondary hypertension

A

Pheochromocytoma

36
Q

Tumor of the adrenal medulla releasing excess amounts of epinephrine/NE

A

Pheochromocytoma

37
Q

Hypertension (sustained or paroxysmal) with paroxysms of symptoms including severe headaches, sweating and palpitations.

A

Pheochromocytoma

38
Q

Diagosis of Pheochromocytoma

A

24 hour urine for catecholamines and metanephrines

39
Q

Treatment of Pheochromocytoma

A

Laproscopic removal of tumor with pre-op admin of alpha blocking drugs (phenoxybenzmine) and beta blockers to reduce perioperative complications

Setha: Endocrine (1 decks)

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