12: Adrenal Diseases - Thompson Flashcards
what does cortisol do?
regulates BP cardiac function immune system mood insulin metabolism
what does aldosterone do?
- BP
- water balance
- na balance
- helps kidneys keep Na and get rid of K
growth on the adrenals leads to increased production of epi and NE
pheochromocytoma
10% tumor
pheochromocytoma - only 10% of the time are they the following things:
malignant 2 side in kids familial recur
sign and symptoms of pheochromocytoma
rapid HR high BP flushed anxiety pale
you should be suspicious when BP not being controlled with meds
get 24 hr urine metanephrines or catecholamines
from a lack of epi/NE
autonomic failure
POTS postural orthostatic tachycardic syndrome
fainting, CP, SOB, fatigue
meds to treat symptoms
failure of adrenals to make enough cortisol
addison’s disease
lack of ACTH from pituitary dysfunction or lack of adrenal function (primary cause- autoimmune)
what type of addisions will keep making aldosterone?
secondary (pituitary dysfunction with lack of ACTH)
wt loss
fatigue
low BP
darkening of skin
addisons
key electrolyte balance for addisons ***
low Glu
low Na
high K
not enough cortisol and patient gets sick
addison’s crisis
steroids - pretreat to avoid with things like surgery
again **low blood sugar, low Na, high K
addisons - give synthetic ACTH, what do you see?
should see increase in cortisol in normal ppl
no increase in addisons
cushings syndrome v. disease
syndrome when caused by adrenal issue
disease when caused by pit. tumor
hyperglycemai, hypernatremia, hypokalemia
cushings
giving steroids for too long and too much
iatrogenic cushings may develop
if cortisol is high, then…
dexamethasone suppresion test (give steroids, body should decrease its own production
new med that reduces cortisol in cushings disease
signifor
should you give extra steroids to a cushing’s pt during stress like you do with addisons?
actually yes
because neither can regulate
hyperaldosteronism =
conn’s disease
may be 5-15% of hypertensives
treatment for conn’s disease
spiranolactone
htn, low K, HA, muscle weakness
conn’s
suspect hyperaldosteronism in pt with resistant htn and low potassium
what glucose issue can be present in up to 20% of those with Conn’s?
glucose intolerance
what acid-base issue may those with conn’s have?
metabolic alkalosis due to low potassium - hydrogen leaves with potassium
