TBL Endocrine Flashcards Preview

Block 10 Week 2 > TBL Endocrine > Flashcards

Flashcards in TBL Endocrine Deck (42):
1

In what ways do secondary forms of hypertension, which are endocrine in origin differ from essential hypertension in which an etiology can be identified?

abrupt onset
greater severity
no positive family history of HTN
no specific age criterion

2

List 3 endocrine diseases that can cause secondary HTN

primary hyperaldosteronism
Cushing's disease
pheochromocytoma

3

Explain the concept of pseudoresisitance

when medications cause tachycardia, volume expansion, and/or RAAS activation --> plasma volume expansion

can occur with alpha & beta blockers or direct vasodilators

4

What is a pheochromocytoma?

a tumor of chromaffin cells of the adrenal medulla --> excess secretion of catecholamines --> increased BP & other symptoms

5

When are most pheochromocytomas detected?

during surgery or abdominal imaging
or during autopsy

6

Pheochromocytoma can be associated with this disease

neurofibromatosis

**pts with neurofibromatosis should be screened for pheo

7

What is the triad of symptoms of a pheochromocytoma?

headache
excessive/generalized sweating
palpitations

**other symptoms: pallor, weight loss, feelings of panic & anxiety

8

What types of blood pressure patterns can emerge with a pheochromocytoma?

sustained HTN without BP spikes
persistent HTN state w spikes reaching crisis level
normotensive state with brief & sudden spikes in BP

9

(blank) is seen in more than 50% of pts with pheochromocytoma

orthostatic hypotension

10

What are the symptoms of a pheochromocytoma-related hypertensive crisis?

dizziness
flushing
visual disturbances
panic/anxiety
nausea
vomiting
epileptic aura

11

What are some diseases that can present like pheochromocytoma?

paroxysmal vasodilating headaches
autonomic dysfunction
anxiety or panic disorder
acute hypoglycemia
CAS
cocaine use

12

What is necessary for the diagnosis of pheochromocytoma?

evidence of excess catecholamine production

13

What tests do you use to diagnose pheo?

measure urine & plasma catecholamines
urine metanephrines & vanillylmandelic acid

14

The best approach for pheochromocytoma screening

looking at catecholamines & their metabolites in timed urinary samples

15

The most sensitive test for pheochromocytoma

plasma free metanephrines

**O-methylated metabolites of catecholamines are continuously seeping from chromaffin tumors

16

T/F: Measurements of fractionated metanephrines are better than total metanephrines

True

17

What can you do if catecholamine levels are elevated but not that much?

give a clonidine suppression test --> if pheochromocytoma, clonidine would not suppress catecholamine release

**failure to suppress plasma catecholamines after clonidine therapy --> pheo

18

What kinds of imaging can be used for pheo?

MRI & CT
I-metaiodobenzylgaunidine (for more specificity)

19

The only effective therapy approach for pheo?

surgical treatment

20

This is essential during surgical removal of pheo...

alpha & beta blockers

21

This should be considered in any patient with spontaneous hypokalemia, moderately severe hypokalemia after using normal doses of diuretics, or refractory HTN

primary hyperaldosteronism

22

Does primary aldosteronism cause edema?

no, because of aldosterone escape

23

Patients with primary hyperaldosteronism often develop this comorbid condition

left ventricular hypertrophy --> heart failure

24

What other diseases present like primary hyperaldosteronism?

SIADH
Liddle's syndrome
licorice ingestion

25

(blank) ingestion increases access of cortisol to its receptor and causes Na+ retension & K+ loss

licorice

26

How to diagnose primary hyperaldosteronism?

low K+ in serum
abnormally high K+ in urine
reduced renin activity
elevated plasma/urine aldosterone

27

How to treat hyperaldosteronism?

remove an adenoma
medical therapy with spironolactone in pts with bilateral adrenal hyperplasia or high operative risk
Eplerenone is a newer option

28

What's Cushing's syndrome?

excess cortisol production

29

Two types of Cushing's syndrome

ACTH-dependent & ACTH independent

30

What causes 80% of ACTH dependent Cushings syndome?

ACTH secreting adenoma

can also be caused by an ACTH secreting small cell carcinoma of the lung

31

What causes the ACTH independent forms of Cushings syndrome?

adrenal adenoma or carcinoma

32

Signs & symptoms of Cushing's disease

buffalo hump
hypertension (increased beta receptors on blood vessels --> increased tone of vasculature)
moon face
proximal weakness
hirtuism
emo distubances
skin abnormalities
insulin resistance
osteoporosis
loss of libido

33

Increased (blank) risk in Cushings patients

cardiovascular

34

How do pts with ectopic ACTH secretion differ from pts with Cushings caused by increased cortisol secretion?

may not have typical symptoms of cortisol excess
instead, skin hyperpigmentation due to MSH overproduction
severe hypertension
hypokalemic alkalosis

35

Most common cause of Cushing's syndrome?

exogenous steroid administration

36

Things that present like Cushings...

fat people with metabolic syndrome & cushingoid appearance
chronic alcohol excess

37

Best test for diagnosing Cushing's syndrome?

24 hr free cortisol

**amount of free cortisol in urine can be decreased by renal disease

38

Test widely used to screen for Cushing's syndrome

dexamethasone suppression test --> exogenous dexamethasone should reduce plasma cortisol values to less than 2 in normal patients

**measure urinary free cortisol as a confirmation test

39

How to treat Cushing's syndrome?

excise the pituitary adenoma

can do adrenalectomy if adrenal adenoma or carcinoma

medical management with ketoconazole if all else fails

40

Other causes of Cushing's disease

insulin resistance
sleep apnea

**both contribute to HTN

41

T/F: Hypertension generally remits with corrective surgery of Cushing's syndrome unless exposure to excess cortisol has been sufficiently prolonged

True

42

(blank) should be avoided in pts with Cushing's syndrome since they increase Ca++ excretion which can exacerbate the negative Ca++ balance state in Cushing's

loop diuretics