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Flashcards in Unrein, addisons, cushings Deck (21):

cortisol level in addisons

low normal basal secretion


how can someone be physiologically normal with cortisol metabolism with either high or low serum cortisol

cortisol is protein bound


how do you Dx addisons

ACTH stimulation test (cosryntropin stim test)


ACTH stimulation test in primary adrenal insufficiency

no change because problem is in adrenal


ACTH in secondary adrenal insufficiency

see a change because problem in pituitary


most common form adrenal insufficiency

iatrogenic- exogenous steroids


BMP in someone with adrenal insufficiency

low Na, high K
metabolic acidosis
volume depletion


how to distinguish between primary and secondary adrenal insufficiency

secondary does not have hyperpigmentation or the severity of electrolyte abnormalities


46 y.o F has noncompliant BP, hypokalemia
on lisinpril HCTZ and K replacement
labs unremarkable
bicarb high

mineralocorticoid excess


29 F with proximal mm weakness, weight gain, dorsal fat pad, round face, abdominal striae
menstrual irregularities
high glucose low K
what lab needed to Dx?

24 hr urine cortisol


DXM suppression test used for what

to distinguish exogenous ACTH production vs pituitary ACTH secretion


low dose DXM suppresses what
high dose DXM suppress what

low dose neither
high dose DXM suppresses pituitary, cannot suppress exogenous


56 M dry cough hoarseness, weight loss, increased weakness, unexplained weight loss
COPD on prednisone
moon facies, truncal obesity, bruising on arms
low K high glucose high urine cortisol
next step in evaluation?

CT scan of the chest


55 y.o M hospitalized pyelonephritis
albuterol, fluticasone, salmeterol, lisinopril and prednisone
Na low, glucose little high
on antibiotics for pyelonpehritis
what else should you do?

iatrogenic adrenal insufficiency
needs stress dose of steroids-- hydrocortisone


how long is someone considered to have adrenal suppression after prolonged course of steorids?

one year


28 y.o F started thyroid replacement hormone for tSH
BP 122/72
BMI22 skin unremarkable
to start levothyroxine, what test can you use to be sure it is safe to start Tx

normal serum Na K and glucose
tells you adrenal-pituitary axis is in tact, safe to start on thyroid replacement


43 y.o F 148/98 BP, high Na low K, high Cl, high glucose, CT show unremarkable adrenal glands
seeing chines herbologist to Tx depression
what finding do you need to confirm Dx?

licorice in chinese herbs


aldosterone renin levels in primary hyepraldosteronism

high serum aldosterone and low serum renin


aldosterone renin levels in secondary hyperaldosteronism

high serum aldosterone and high serum renin


22 y.o M hypotension and unconsciousness. sore thraoat, purpuric rash on palms and soles and HA
smoke 5 pack years
no vaccines
CT on chest you expect to find

waterhouse-friederichson syndrome
- could have meningitis, coxsackie, rickettsia, syphilis
Tx with antibiotics and lumbar puncture for culture. also need steroids to Tx meningitis


45 y.o M with fatigue
10 yrs ago had tanssphenoidal hypophysectomy for removal pituitary adenoma
small testes
what test to you order to evaluate fatigue?

serum free cortisol and free T4
want to know if being Tx with enough exogenous hormones