Adrenal 2 Flashcards
What is primary hyperaldosteronism?
Excess production of aldosterone by the adrenal glands
What are the 2 causes of primary hyperaldosteronism?
- Adrenal cortical hyperplasia (idiopathic)- MC
- Adrenocortical adenoma–> Conn’s syndrome
What should you think if you have a young adult who has HTN but does not have any risk factors or FHx
Primary hyperaldosteronism
CPx of what?
- HTN (young adult or resistant HTN)
- HA
- blurred vision
- mm. weakness
- paresthesias
- polydipsia/polyuria
- *won’t present with dehydration*
Primary hyperaldosteronism
How do oyu diagnose Primary hyperaldosteronism? (5)
- CMP: hypokalemia, hypernatremia
- Incr. plasma/urine aldosterone
- Decreased plasma renin
- **Saline infusion test- Plasma aldosterone level >10
- CT adrenals to eval for adrenal adenoma
How do you tx primary hyperaldosteronism?
- Surgical removal of adenoma
- Medical: Spironolactone and antihypertensives
a Pheochromocytoma arises from what cells?
Chromaffin cells
Are PHEOs usually malignant?
NO
10% malignant
Pheochromocytomas are associated with what 2 genetic syndromes
MEN2
Neurofibromatosis
CPx of what:
- Paroxysmal attacks lasting 30-40min
- Paroxysmal palpitations (tachycardia), HA and episodic sweating
Pheochromocytoma
Sxs of pheochromocytomas are often precipitated by what
displacement of abdominal cavity (sitting, bending, deep palpation)
Pheochromocytomas are sometimes a/w which cardiomyopathy
stress induced (takutsubo) cardiomyopathy
How do you dx a pheochromocytoma?
- 1st line screening= Metanephrrine in 24hr urine
- Clonidine suppression test (Pheo: catecholamine levels dont decr)
- CT abd
- MIBG scintigraphy (identify extra-adrenal tumors)
How do you tx a pheochromocytoma?
surgical resection
What 2 meds do you give prior to surgical resection of pheochromocytoma?
- Alpha-adrenergic blocker (phenoxybenzamine)- titrated until BP and sxs controlled
- Beta blocker (Propanolol)- overcome tachycardia
What is an adrenal incidentaloma?
mass >1cm found incidentally
There is an increased prevalence of adrenal incidentalomas in which 3 patient populations
obese, hypertensives, DM patients
are most adrenal incidentalomas functional or non-functional?
non-functional
What are 6 characteristics of a BENIGN adrenal incidentaloma seen on MRI?
**If don’t see the following–> REFER**
- Homogenous
- Unilateral
- Diameter <4cm
- LIpid rich (attenuation <10Hu)
- Rapid contrast washout
- Isointensity compared to liver on T1 and T2 (should be same color as liver
How do you determine if an adrenal incidentaloma is hyperfunctioning? (what tests should be ordered if there are sxs of cushings? If you suspect a pheo?)
- Plasma cortisol, serum ACTH, serum DHEA, plasma aldosterone
- sxs of cushings?
- Yes- 24 hr urine cortisol
- No- Dexamethasone suppression test
- Suspicion for pheo?
- 24hr urine for metanephrines, catecholamines
When is a fine needle aspiration/bx of an adrenal incidentaloma contraindicated ? (2)
- Biochem evidence of pheo
- Known widespread mets
How do you tx an adrenal incidentaloma if it is benign in appearance?
(if > 2cm? < 2cm?)
- >2 cm= resection
- < 2cm= repeat imaging @6mo
- repeat dexamethasone suppression test annual x4 yrs
Which condition do you use the saline infusion test for?
Primary hyperaldosteronism
Which condition do you use the clonidine suppression test to test for?
pheochromocytoma
Wha tis the Dexamethasone Suppresion test used for?
Test for Hypercortisolism (Cushings syndrome)
What is the ACTH stimulation test for?
Adrenal insufficiency
What 2 conditions does a Plasma ACTH level test for?
- Adrenal insufficiency
- Hypercortisolism
