16 Endocrine Hypertension

Question 1

Preoperative alpha adrenergic blockade should be started how many days preoperatively in the treatment of catecholamine-secreting neoplasms?

Answer 1

7-10 days

Question 2

In the preoperative management of catecholamine-secreting neoplasms, longer therapy duration of alpha adrenergic blockade is indicated in the following (3)

Answer 2

Recent MI
Catecholamine CMP
Catecholamine-induced vasculitis

Question 3

Target preoperative blood pressure in the treatment of catecholamine-secreting neoplasms

Answer 3

<120/80 mm Hg (seated)
>90 mm Hg SBP (standing)

Question 4

High sodium diet is started on what day of alpha adrenergic blockade?

Answer 4

2nd or 3rd day

Question 5

Target sodium content of diet during alpha adrenergic blockade

Answer 5

≥5 g/day

Question 6

Reasons (2) why diet high in sodium is recommended during alpha adrenergic blockade

Answer 6

Catecholamine-induced contraction
Orthostasis associated with alpha adrenergic blockade

Question 7

Possible contraindications to volume expansion during alpha blockade (2)

Answer 7

Congestive heart failure
Renal insufficiency

Question 8

Beta adrenergic blockade is typically started how many days preoperatively for pheochromocytoma and paragangliona?

Answer 8

2-3 days preoperatively

Question 9

Preferred drug for preoperative preparation to control blood pressure and arrhythmia in pheochromocytoma and paraganglioma

Answer 9

Phenoxybenzamine

Question 10

Initial dosage for phenoxybenzamine in the preoperative preparation for catecholamine-secreting tumors

Answer 10

10 mg OD or BID

Question 11

Maximum daily dosage for phenoxybenzamine in the preoperative preparation for catecholamine-secreting tumors

Answer 11

100 mg

Question 12

Initial daily dosage for prazosin in the preoperative preparation for catecholamine-secreting tumors

Answer 12

1 mg

Question 13

Maximum daily dosage for prazosin in the preoperative preparation for catecholamine-secreting tumors

Answer 13

20 mg

Question 14

Initial daily dosage for terazosin in the preoperative preparation for catecholamine-secreting tumors

Answer 14

1 mg

Question 15

Maximum daily dosage for terazosin in the preoperative preparation for catecholamine-secreting tumors

Answer 15

20 mg

Question 16

Initial daily dosage for doxazosin in the preoperative preparation for catecholamine-secreting tumors

Answer 16

1 mg

Question 17

Maximum daily dosage for doxazosin in the preoperative preparation for catecholamine-secreting tumors

Answer 17

20 mg

Question 18

Pheochromocytoma and paraganglioma:
Alpha-adrenergic blocking agent given OD

Answer 18

Doxazosin

Question 19

Pheochromocytoma and paraganglioma:
Alpha-adrenergic blocking agents given BID (2)

Answer 19

Terazosin
Phenoxybenzamine

Question 20

Pheochromocytoma and paraganglioma:
Alpha-adrenergic blocking agent given TID-QID

Answer 20

Prazosin

Question 21

Alpha-adrenergic blocking agent with first-dose effect (3)

Answer 21

Doxazosin
Prazosin
Terazosin

Question 22

Alpha-adrenergic blocking agent with retrograde ejaculation as side effect

Answer 22

Phenoxybenzamine

Question 23

Alpha-adrenergic blocking agents (3) with fatigue as side effect

Answer 23

Doxazosin
Phenoxybanzamine
Prazosin

Question 24

Alpha-adrenergic blocking agents (2) with nasal congestion as side effect

Answer 24

Phenoxybenzamine
Terazosin

Question 25

Alpha-adrenergic blocking agents (2) with somnolence as side effect

Answer 25

Doxazosin Terazosin

Question 26

Combined alpha and beta adrenergic blocking agent used to treat pheochromocytoma

Answer 26

Labetalol

Question 27

Maximum daily dosage for labetalol in the treatment of pheochromocytoma

Answer 27

1200 mg

Question 28

Initial daily dosage for labetalol in the treatment of pheochromocytoma

Answer 28

200 mg

Question 29

Maximum daily dosage for oral nicardipine in the treatment of pheochromocytoma

Answer 29

120 mg

Question 30

Initial daily dosage for oral nicardipine in the treatment of pheochromocytoma

Answer 30

30 mg

Question 31

Maximum daily dosage for metyrosine in the treatment of pheochromocytoma

Answer 31

4 g

Question 32

Initial daily dosage for metyrosine in the treatment of pheochromocytoma

Answer 32

1 g

Question 33

Oral drug used to treat pheochromocytoma with the ff side effects: Sedation, diarrhea, anxiety, nightmares, crystalluria, galactorrhea, extrapyramidal symptoms

Answer 33

Metyrosine

Question 34

Adverse effects of pheoxybenzamine (4)

Answer 34

Orthostasis Nasal congestion Retrograde ejaculation Marked fatigue

Question 35

Characteristics of phenoxybenzamine: Irreversible / reversible Long-acting / short acting Nonspecific / specific Alpha / beta blocking agent

Answer 35

Irreversible, long-acting, nonspecific alpha adrenergic blocking agent

Question 36

Pheochromocytoma should be suspected in the ff (9):

Answer 36

Hyperadrenergic spells Resistant hypertension Familial syndrome that predisposes to catecholamine-secreting tumors Family history of pheochromocytoma Incidentally discovered adrenal mass with imaging characteristics consistent with pheochromocytoma Pressor response during anesthesia, surgery, or angiography Onset of hypertension at a young age (<20 years) Idiopathic dilated cardiomyopathy Cyanotic congenital heart disease

Question 37

Onset of hypertension at what age should pheochromocytoma be suspected?

Answer 37

<20 years

Question 38

Typical imaging phenotypes of adrenal masses: Size of cortical adenoma

Answer 38

<3 cm

Question 39

Typical imaging phenotypes of adrenal masses: Size of cortical carcinoma

Answer 39

>4 cm

Question 40

Typical imaging phenotypes of adrenal masses: Size of pheochromocytoma

Answer 40

>3 cm

Question 41

Typical imaging phenotypes of adrenal masses: Tumor types that have round to oval shape with smooth margins (2)

Answer 41

Cortical adenoma Pheochromocytoma

Question 42

Typical imaging phenotypes of adrenal masses: Shape of cortical carcinoma

Answer 42

Irregular with unclear margins

Question 43

Typical imaging phenotypes of adrenal masses: Shape of adrenal metastasis

Answer 43

Oval to irregular with unclear margines

Question 44

Typical imaging phenotypes of adrenal masses: Texture of cortical adenoma

Answer 44

Homogenous

Question 45

Typical imaging phenotypes of adrenal masses: Texture of cortical carcinoma

Answer 45

Inhomogenous

Question 46

Typical imaging phenotypes of adrenal masses: Texture of pheochromocytoma

Answer 46

Inhomogenous with areas of cystic degeneration

Question 47

Typical imaging phenotypes of adrenal masses: Texture of metastasis

Answer 47

Inhomogenous

Question 48

Typical imaging phenotypes of adrenal masses: Laterality of cortical adenoma

Answer 48

Usually unilateral

Question 49

Typical imaging phenotypes of adrenal masses: Laterality of cortical carcinoma

Answer 49

Usually unilateral

Question 50

Typical imaging phenotypes of adrenal masses: Laterality of pheochromocytoma

Answer 50

Usually unilateral and solitary

Question 51

Typical imaging phenotypes of adrenal masses: Laterality of adrenal metastasis

Answer 51

Often bilateral

Question 52

Typical imaging phenotypes of adrenal masses: Tumor type with limited contrast enhancement

Answer 52

Cortical adenoma

Question 53

Typical imaging phenotypes of adrenal masses: Tumor type with marked contrast enhancement (3)

Answer 53

Cortical carcinoma Metastasis Pheochromocytoma

Question 54

Typical imaging phenotypes of adrenal masses: Precontrast CT attenuation and washout of cortical adenoma

Answer 54

<10 HU >50% washout

Question 55

Typical imaging phenotypes of adrenal masses: Precontrast CT attenuation and washout of cortical carcinoma

Answer 55

>10 HU <50% washout

Question 56

Typical imaging phenotypes of adrenal masses: Precontrast CT attenuation and washout of pheochromocytoma

Answer 56

>10 HU <50% washout

Question 57

Typical imaging phenotypes of adrenal masses: Precontrast CT attenuation and washout of metastasis

Answer 57

>10 HU <50% washout

Question 58

Typical imaging phenotypes of adrenal masses: Tumor type that is isointense on MRI

Answer 58

Cortical adenoma

Question 59

Typical imaging phenotypes of adrenal masses: Tumor type that is hyperintense on MRI (3)

Answer 59

Cortical carcinoma Metastasis Pheochromocytoma

Question 60

Typical imaging phenotypes of adrenal masses: Tumor type where necrosis, hemorrhage, or calcifications are rare

Answer 60

Cortical adenoma

Question 61

Typical imaging phenotypes of adrenal masses: Growth of cortical adenoma

Answer 61

Slow

Question 62

Typical imaging phenotypes of adrenal masses: Growth of cortical carcinoma

Answer 62

Rapid

Question 63

Typical imaging phenotypes of adrenal masses: Growth of pheochromocytoma

Answer 63

0.5-1 cm/yr

Question 64

Typical imaging phenotypes of adrenal masses: Growth of metastasis

Answer 64

Variable