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Q3 Clin Med II Final (Endocrine) > Adrenal > Flashcards

Adrenal Flashcards

1
Q

Adrenal Medulla secretes?

A

Catecholamines:

Epi, Norepi

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2
Q

Adrenal Cortex: Zona Glomerulosa secretes?

A

Mineralcorticoids: Aldosterone

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3
Q

Adrenal Cortex: Zona Fasciculata secretes?

A

Glucocorticoids: Cortisol

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4
Q

Adrenal Cortex: Zona Reticularis secretes?

A

Androgens: DHEA

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5
Q

Adrenal hormones excreted how?

A

Urine as metabolites

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6
Q

Cushing’s Synd/ACTH-dependent caused by?

A

1) Excess ACTH from pituitary tumor ** most common
2) Excess ACTH from ectopic tumors (i.e. small cell lung CA)
3) Excess CRH from hypothalm

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7
Q

Cushing’s Synd/ACTH-independent caused by?

A

1) Adrenal tumor
2) Hyperplasia from excess receptor/hormone
3) Neuroendrocrine tumor
4) Pheochromocytoma (medulla tumor)

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8
Q

Cushing’s Synd/ACTH-dependent epidemiology?

A

More common
F»M
25-45yo

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9
Q

Cushing’s Synd/ACTH-independent epidemiology?

A

M=F

Bimodal age

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10
Q

Cushing’s presentation?

A 
Weight gain
Proximal mm fatigue/weakness
Straie
Acne/hair
Edema
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11
Q

Cushing’s physio ∆s?

A 
HTN
Insulin resistance
Osteoporosis/hyperCa2+ 
Psych
Clitoral hypertrophy
Impotence
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12
Q

Cushing’s labs? (5)

A

Easiest/cheapest: DST = cortisol >5

Definitive: 24 hr urine cortisol > 125

Plasma cortisol = high

Serum ACTH = high in ACTH-dep and low in indep

Saliva = high cortisol in p.m.

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13
Q

Cushing’s management?

A

Remove/destroy tumors

Inoperable, see meds

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14
Q

Cushing’s tx w/ meds?

A

Adrenolytic (Mitotane): destruction of adrenocortical cells

Adrenal Enz Inhib (Ketoconazole, Metyrapone)

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15
Q

Virilization is?

A

development of male physical characteristics

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16
Q

Adrenal Insufficiency is?

A

Inadequate prdxn of mineral/gluco/androgen hormones

17
Q

Primary Adrenal Insufficiency caused by? (2 categories)

A

Destruction of gland:
Autoimm, surgical, infect, CA

Metabolic failure:
adrenal hyperplasia, adrenoleukodystrophy

18
Q

Most common cause of Primary Adrenal Insufficiency?

A

Addison’s (autoimmune)

19
Q

Secondary Adrenal Insuff caused by?

A

Abrupt stop of external steroid (most common)
Hypopituitary
Steroid-reducing drugs

20
Q

Adrenal Insuff presentation?

A 
TETRAD:
Weak/fatigue
Weight loss
Hyperpigment (include muc memb)
HypoTN
21
Q

Adrenal Insuff from ↓ glucocort presentation?

A

Tetrad
+ hypoglycemia
N/V abd pain

22
Q

Adrenal Insuff from ↓ mineralcocort presentation?

A

Tetrad
+ hypoNa+/hypovol
HyperK+
Acidosis

23
Q

Adrenal Insuff from ↓ androgens presentation?

A

Tetrad

+ Ø pubic hair/amenorrhea in women

24
Q

Adrenal Insuff labs?

A

Cosyntropin Stim Test: baseline cortisol then post ACTH bolus cortisol
+ result = cortisol Ø ↑ > 18 AND Ø ↑ > 7 above baseline
(doesn’t tell me cause)

Plasma cortisol = low
Serum ACTH = high (addison’s), low (hypopitu)

25
Q

Adrenal Insuff diagnositcs must r/o?

A

TB (PPD test)
Lung/Breast CA
Vascular dz

26
Q

Adrenal Insuff rx?

A

Replace hormones

Increase glucocort during stress

27
Q

Primary Hyperaldosteronism (Conn Synd) caused by?

A

(U) Adrenocortical adenoma

Cortical hyperplasia

28
Q

Conn synd presentation?

A 
HTN
HypoK+
mm weakness
Paresthesia
HA
Polyuria/Polydipsia
29
Q

Conn Synd labs/test?

A

Plasma and urine aldosterone = high
Plasma renin = low
CT for adenoma

30
Q

Conn Synd tx?

A

Remove tumor

Spironolactone/antihypertensives

31
Q

Pheochromocytoma is?

A

Catecholamine-producing tumor of neurochromaffin cells

32
Q

Pheochromocytoma epidemiology?

A

Sporadic or Familial
any age (peak 40-50yo)
Fatal if not tx

33
Q

Pheochromocytoma etiology?

A

(U) in medulla
or extra-adrenal
(P) neurofibromatosis

RULE OF 10s

34
Q

Extraadrenal Pheochromocytoma located?

A

SNS spinal chain
Aorta
Ureter
Bladder

35
Q

Pheochromocytoma presentation?

A

Paroxysm attacks:
HA, sweating, palp, acute HTN

(P) mass
Thyroid storm

36
Q

Key point of Pheochromocytoma-caused HTN?

A

If pt HTN not responding to tx, workup for catecholamine excess

37
Q

Pheochromocytoma labs?

A

Definitive: Clonidine Suppress Test = no epi reduction after clonidine

Thyroid fxn
Plasma/urine catecholamnies/metabolites
24 hr urine catech, metaneph, VMA

38
Q

Causes of false + for catecholamines/metanephrines?

A 
TCA
Beat block
Acetamin
ETOH
HTN med w/draw
MI/stroke/sleep apnea
39
Q

Pheochromocytoma tx?

A

IV nitro for crisis
Chemical sympathectomy w/ alpha block (surgical prep)
Surgery

Q3 Clin Med II Final (Endocrine) (6 decks)

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