Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Adult Clinical Medicine > Adrenal and Pituitary Disorders > Flashcards

Adrenal and Pituitary Disorders Flashcards

1
Q

where do the adrenal glands sit

A

on kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

describe the anatomy of the adrenal gland

A

Outer to inner:

  1. adrenal cortex
  2. zona glomerulosa- aldosterone
  3. zona fasciculata- cortisol
  4. zona reticularis- androgens (testosterone)
  5. medulla- catecholamines
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

4 divisions of the adrenal gland and what they release

A
  1. zona glomerulosa- aldosterone
  2. zona fasciculata- cortisol
  3. zona reticularis- adrenal androgens (testosterone)
  4. medulla- catecholamines (aka adrenaline)

*each division essentially acts as an independent organ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is so important about the zona glomerulosa

A
  1. secretes aldosterone
  2. tied to renin stimulatin
  3. important for BP control
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is so important about the zona fasciculata

A
  1. releases cortisol
  2. tied to ACTH
  3. effects the immune system, inflammation, BP
  4. stress hormone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is so important about the medulla

A
  1. releases catecholamines
  2. stress hormone
  3. essentially a sympathetic ganglion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the hypothalamic pituitary adrenal axis?

A

Stress stimulates Hypothalamus–> releases CRH–> stimulates pituitary–> releases ACTH–> stimulates adrenal glands–> releases testosterone, aldosterone, and cortisol

-cortisol neg. feedback on pituitary and hypothalamus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what hormones does the anterior pituitary release and what are its target

A
  1. Adrenocorticotropic Hormone (ACTH)–> adrenal
  2. Growth Hormone–> liver
  3. Prolactin–> mammillary glands
  4. Thyroid Stimulating Hormone (TSH)–> thyroid
  5. Luteinizing Hormone (LH)–> ovaries-testicles
  6. Follicle Stimulating Hormone (FSH)–> ovaries-testicles

*FLAT PiG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

categories of adrenal disorder

A
  1. hormone over-production
  2. hormone under-production
  3. adrenal tumors (often incidental findings)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

types of hormone over-production adrenal disorders

A
  1. Cortisol –> Cushing’s Syndrome
  2. Catecholamines –> Pheochromocytoma
  3. Aldosterone –> Hyperaldosteronism
  4. Androgens –> Virilism, PCOS?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

types of hormone under-production adrenal disorders

A
  1. adrenal insufficiency
    - Primary: Addison’s disease
    - Secondary: Pituitary Disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is primary adrenal insufficiency

A

-adrenal gland doesn’t make enough hormone (low testosterone, aldosterone, and cortisol) despite normal signaling from hypothalamus and pit. (elevated CRH and ACTH)

hypothalamus releases increased CRH–> stimulates ant. pituitary to release increased ACTH–> Adrenal cannot release HR**–> decrease testosterone, aldosterone, and cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Etiology of primary adrenal insufficieny

A
  1. Autoimmune: Addison’s Disease (80%) -Think esp in setting of other autoimmune disorders (#1 cause was previously TB)
  2. Infections: TB, HIV, CMV, fungus
  3. Metastatic disease
  4. other Rare causes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

other rare causes of primary adrenal insufficieny

A
  1. Adrenal hemorrhage, infarction
  2. Infiltrative diseases: sarcoid, amyloid, hemochromatosis
  3. Meds: enzyme inhibitors, cytotoxic agents
  4. Surgery, XRT (radiation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is secondary adrenal insufficiency

A

-adrenal gland is not getting stimulated adequately (low cortisol, normal testosterone and aldosterone) due to problem w/ hypothalamus or pit. (low CRH and low ACTH)

hypothalamus does not release CRH–> ant. pit. does not release ACTH–> decrease cortisol and Testosterone aldosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

etiology of secondary adrenal insufficiency

A
  1. pituitary
    - tumors, trauma, XRT, infiltrative disease, apoplexy: hemorrhage, infarction, Sheehans
  2. hypothalamic
    - glucocorticoid therapy (most common), other drugs, tumors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

symptoms of adrenal insufficiency

A
  1. fatigue
  2. weakness
  3. myalgias
  4. arthralgia
  5. anorexia
  6. N/V
  7. HA
  8. Abdominal pain
  9. weight loss
  10. postural dizziness*
  11. salt craving*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

PE signs of adrenal insufficiency

A
  1. hypotension (seen less w/ secondary)
  2. tachycardia*
  3. fever
  4. vitiligo (hypo-pigmentation) (Primary only)
  5. hyperpigmenation–> bc ACTH stimulates melanin (primary only)
  6. abdominal tenderness/guarding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what labs for adrenal insufficiency

A
  1. hyperkalemia (primary only)
  2. hyponatremia
  3. hypoglycemia
  4. azotemia (increase BUN/Cr)
  5. anemia
  6. eosinohilia (Addison’s)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

how do you diagnose adrenal insufficiency

A

**If you don’t have enough–> try to stimulate it

  1. Random Cortisol greater than 3 µg/dl
  2. Cosyntropin Stimulation Test (Gold Standard)
    Standard test:
    -Baseline cortisol level (ideally in AM)
    Give 250 µg cortrosyn (ACTH) IV (or IM)
    -Measure cortisol at 30, 60 minutes
    -Adrenal Insufficiency = 30/60 min Cortisol less than 20 µg/dl
  3. imaging?– not unless you suspect metastatic disease

*Cosyntropin= synthetic ACTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how do you differentiate between primary vs secondary adrenal insufficiency

A

ACTH greater than 100 pg/ml in Primary adrenal insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Tx of acute adrenal insufficiency

A
  1. Hydrocortisone 100 mg IV q 8 hrs
    - Can also use dexamethasone if cannot wait for Cort Stim Test
  2. Hydration and BP Support: saline, pressors
  3.   Rule out and treat precipitating factors: (trauma, infection, dehydration)
  4. Taper as quickly as clinical condition allows
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Tx of chronic primary adrenal insufficiency

A
  1. Hydrocortisone ~30 mg/d (2-3 divided doses)
  2. +/- mineralocorticoid (aldosterone effect)
  3. Consider DHEA in women
  4. pt education

*use lowest dose possible to avoid complications.(Cushing’s syndrome, osteoporosis, DM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Tx of chronic secondary adrenal insufficiency

A
  1. prednisone ~5mg once daily (pure glucocorticoid– no mieralocorticoid effect)
  2. pt education

*use lowest dose possible to avoid complications.(Cushing’s syndrome, osteoporosis, DM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what do you need to educate your patient on when treating for adrenal insufficiency
- stress/illness dosing of steroids | - medical alert, family education
26
___ is uncommon in traditional primary care practice, 5-8% of patients with hypertension
Secondary hypertension *high rate of false positives
27
secondary causes of HTN
1. endocrine causes | 2. non-endocrine causes
28
endocrine causes of secondary HTN
1. Adrenal: - Primary Aldosteronism - Cushing’s Syndrome - Pheochromocytoma 2. Non-Adrenal - Hypo- or Hyperthyroidism - Hyperparathyroidism - Acromegaly
29
non- endocrine causes of secondary HTN
1. Renal Parenchymal Dz 2. Renovascular HTN - Age over 55, known CVD, worsening renal function on ACE or ARB 3. Coarctation of the Aorta 4. Severe Obesity 5. Insulin Resistance 6. Sleep Apnea 7. Alcohol Abuse 8. Oral contraceptives 9. Ureteral/Bladder Obstruction
30
when to screen for secondary/endocrine HTN
 1. Age less than 30 (esp with no risk factors) 2. Severe/Resistant HTN - End organ damage 3. Family History of Endocrine Disease 4. “Spells”- Labile Hypertension 5. Worsening BP after β-Blockers (suggests pheochromocytoma) 6. Hypokalemia (on low dose diuretic) 7. Premenopausal Osteoporosis (think of Cushing's)
31
describe the renin angiotensin aldosterone system
liver secretes angiotensionogen and kidney secretes renin--> renin cuts angtiotensiongen into angiotensin I--> cut by ACE in lungs--> angiotensin II--> vasoconstriction and stimulates adrenal gland --> adrenal gland (zona glomerulosa) releases aldosterone--> Na retention and K excretion in the kidneys
32
what is primary aldosteronism
aka Conn's syndrome -Too much production of aldosterone by the adrenal glands resulting in low renin levels, vasoconstriction, Na retention/K excretion= HTN
33
what can primary aldosteronism cause
- HTN - hypokalemia - metabolic alkalosis
34
main subtypes of primary aldosteronism
1. aldosterone producing adenoma (APA)- 34% (curable) | 2. idiopathic hyperaldosteronism- 66% (aka hyperplasia of adrenal glands)
35
who is screened for aldosteronism?
hypertensive patients with: 1. hypokalemia: spontaneous or provoked w/ diuretics 2. Severe HTN ( over 160/100) 3. resistant HTN (over 2 drugs) 4. HTN onset less than 20-30 yrs old 5. Adrenal incidentaloma
36
Screening tests for primary aldosteronism
1. MORNING Blood Sample (seated) for: -Plasma Aldosterone (PA) - high -Plasma Renin Activity (PRA) - low 2. Positive Screen: PA/PRA ratio over 20 and PA over 15 ng/dl *PA(H) : PRA (L) ratio is key
37
screening issues for primary aldosteronism
1. stop meds that affect the RAAS system 2. supplement potassium to maintain a level of at least 0.3 mmol/L 3. Do not restrict salt
38
what meds affect the RAAS system that need to be stopped prior to screening for primary aldosteronism
1. Spironolactone, estrogens for 6 weeks 2. ACE, ARB, diuretics, NSAIDS, β-blockers, nondihydropyridine CCBs for 2 weeks 3. Hydralazine, verapamil, alpha blockers have least impact on PA/PRA ratio
39
confirmation tests for primary aldosteronism
1. Sodium Suppression Testing - Oral Salt Loading (High Na Diet x 3 days) - IV Saline Infusion (2 L NS over 4 Hours) 2. diagnostic results: - Oral Salt Loading Test (High Na Diet)- 3rd Day: 24 hr Urine Aldosterone over 12 ug - IV Saline Test- PA over 10 ng/dl
40
when would you need unilateral adrenalectomy (APA)
*Only get abdominal CT if confirmation tests are positive (endocrinologist would order these) 1. unilateral hypodense nodule on CT greater than 1cm and less than 40 y/o 2. unilateral hypodense nodule on CT greater than 1cm, over 40, and lateralization w/ adrenal vein sampling 3. normal or micronodularity or bilateral mass on abdominal CT, and lateralization w/ adrenal vein sampling
41
when would you need medical management for primary aldosteronism (IHA)
1. normal or micronodularity or bilateral mass on abdominal CT--> APA unlikely 2. normal or micronodularity or bilateral mass on abdominal CT w/ likely APA, and NO lateralization w/ adrenal vein sampling 3. unilateral hypodense nodule on CT greater than 1cm, over 40, and NO lateralization w/ adrenal vein sampling
42
how do you treat primary aldosteroneism (APA)
pre-op: aldosterone antagonist (spironolactone, Eplerenone) THEN adrenalectomy: laparoscopic open
43
how do you treat primary aldosteroneism (IHA)
``` aldosterone antagonist (spironolactone, eplerenone) PLUS hypertension meds (thiazide, CCB, ACE I, ARB) ```
44
causes of Cushing Syndrome
1. Ectopic ACTH secreting tumor 10% 2. ACTH secreting pit. tumor 80% 3. cortisol secreting adrenal tumor 10% 4. exogenous corticosteroids *all increase cortisol release
45
clinical features of Cushing Syndrome
1. Central obesity 2. Plethora 3. "Moon” facies (compare old pics) 4. Menstrual irregularities 5. Hirsutism 6. Decreased libido 7. Hypertension 8. Lethargy, depression 9. Proximal muscle weakness 10.   Purple striae (stretch marks are normally skin colored) 11. Easy bruising 12.   Dorsal cervical fat pad 13. acne *normal pulse
46
Who do you screen for cushing syndrome?
1. Symptoms and signs of Cushing’s 2. Hypertension 3. Hyperglycemia, insulin resistance 4. Low bone density 5. Adrenal Incidentaloma or pit. tumor
47
why does someone w/ cushing syndrome have HTN
- Sodium retention from cortisol - Increased production of mineralocorticoids - Hypokalemia (esp with ectopic tumors)
48
screening tests for cushing syndrome
**Too much HR so try to suppress it! 1. low dose dexamethasone suppression test (in AM) 2. 24 hr urinary free cortisol 3. late night (midnight) salivary cortisol --cortisol is lowest at midnight bc it has a diurnal release pattern (highest in AM, lowest in PM)
49
what is the low dose dexamethasone suppression test
*screening test for cushings syndrome - 1 mg at 10-11 pm and measure 8 AM cortisol - Normal less than 1.8mg/dl - less than3% false negative
50
pros and cons of the low dose dexamethasone suppression test
Pros: easy, cheap Cons: lower specificity, false positives with obesity, depression
51
what is the 24 hr urinary free cortisol test (pros and cons)
* screening test for Cushing's syndrome - Cushing’s Syndrome: greater than 4 x normal Pros: high sensitivity and specificity Cons: 24-hr urine collection, multiple collections
52
effects of medicine on cortisol: | -decrease metabolism
- ritonavir, fluoxetine, diltiazem, cimetidine, itraconazole | - Results in potentail false negative
53
effects of medicine on cortisol: | -increase metabolsim
- phenobarb, rifampin, dilantin, tegretol, pioglitazone | - Results in potential false positives
54
effects of medicine on cortisol: | -increase cortisol binding globulin
- estrogens, mitotane | - Results in potential false positives
55
effects of medicine on cortisol: | -increase urinary free cortisol
- tegretol , fenofibrate, licorice (inhibits 11OH steroid dehydrogenase) - Results in potential false positives
56
subtypes of Cushings syndrome
1. ACTH independent | 2. ACTH dependent
57
Cushing’s Syndrome Confirmation and Subtype Differentiation
repeat 24 hr urinary free cortisol --> ACTH level 1. ACTH independent: ACTH less than 10 pg/ml - adrenal - imaging of Abd (CT or MRI) 2. ACTH dependent: ACTH greater than 20 pg/ml - pituitary or ectopic - High dose dexaethasone suppression test - MRI of sella/pituitary - Inf petrosal sinus sampling
58
Tx of Cushings Disease
(pituitary) | -transphenoidal surgery
59
tx of Cushing syndrome from adrenal tumor
laproscopic surgery
60
tx of Cushing syndrome from ectopic ACTH
1. Surgery (carcinoid) 2. Chemotherapy (small cell ca) 3. Bilateral adrenalectomy
61
what is pheochromatocytoma
rare tumor of adrenal gland tissue. It results in the release of too much catecholamies (epinephrine and norepinephrine) *secretes catecholamines episodically so you get "spells"
62
what can pheochromacytoma cause
- HTN - HA - Sweating (w/ pallor NOT FLUSHING) - palpitations
63
prevalence of phenochromocytoma is ____
Prevalence is Low: 1/1,000-10,000 of hypertensive patients * Frequently Sought, but Rarely Present: - 1/200 of those investigated
64
what is the rule of 10's w/ phenochromocytoma
10% are Malignant 10% are Familial 10% are Bilateral 10% are Extra-Adrenal **most are benign
65
who do you screen for phenochromocytoma
1. Spells - HAs, Sweating, Palpitations - Not flushing 2. Severe HTN (episodic) 3. Resistant HTN - But orthostatic hypotension 4. Shock or hypertensive crisis at surgery delivery,anesthesia 5. Adrenal Incidentaloma 6. Familial Syndrome
66
how do you screen for phenochromocytoma
1. 24-hr Urine Metanephrines -Positive: over 1,300 ug/24 hr 2. 24-hr Urine Catecholamines Positive: over 2 fold elevated 3. Plasma Metanephrines -Positive Metanephrine: over 0.5 nmol/L -Positive Normetanephrine: over 2 fold 4. Chromogranin A level (rises on PPIs)
67
what is the sensitivity and specificity of: - Urine metanephrines plus catecholamines - plasma metanephrines (screening tests for pheochromocytoma)
- Urine metanephrines plus catecholamines Sen: 90%, Spec: 98% - plasma metanephrines Sen: 97%, Spec 85%
68
what things can cause a false positive when testing for pheochromocytoma
1. meds 2. alcohol 3. renal failure 4. sleep apnea 5. physical stress and acute illness
69
what meds can cause a false positive when testing for pheochromocytoma
- Levodopa, tricyclics, buspirone (and other anti-psychotics), amphetamines, vasoconstrictors, opioids, acetaminophen* (plasma metanephrines) - Clonidine withdrawal
70
when do you refer to an endocrinologist when evaluating pheochromacytoma
1. - Urine catecholamines over 2x ULN - Urine metanephrine over 400 ug - Urine normetanephrine over 900 ug - Plasma metanephrine over 2x ULN 2. abdominal MRI or CT 3. refer
71
what do you do if you have high clinical suspicion of pheochromocytoma and the 24 hr urine metanephrines, catecholamines, plasma: metanephrines were normal?
check during a spell
72
tx of pheochromocytoma
1. pre-operative: -alpha blocker (1st**), Beta blocker (2nd) or calcium channel blocker THEN 2. Adrenalectomy: laproscopic open * Rx effects from pre-op tx: - vasodilation - volume expansion - rate control *always need to start alpha blocker before beta blocker or else you will have increase alpha binding
73
how do you evaluate spells
1. Pheo? Boderline elevated BP; “episodes of sweats”; Flushing is not a symptom of pheo 2. Perimenopausal? Could check an FSH 3. Carcinoid? Could do 24-hr urine for 5-HIAA 4. Depression/Anxiety?
74
how do you evaluate fatigue
1. Hypothyroidism? Check TSH 2. Cushing’s? No clear sx or signs except fatigue, wt gain, irregular periods, depression. Could do a LDDST 3. Poor Sleep? 4. Depression?
75
why do we care about incidental adrenal masses, and what do we do next to assess
1. HR secreting? 2. benign adenoma vs malignant? - screen for hormone hypersecretion (subclinical) - screen for malignancy
76
when screening for hormone hypersecretion in an incidental adrenal mass what are you looking for?
1. Cushing’s: LDDST, 24-hr UFC 2. Pheo: 24-hr urine for metanephrines, catecholamines 3. Aldosteronism: PA/PRA if hypertensive +/- low K+ 4. Testosterone: look for signs of virilization in women
77
how do you screen for malignancy in an incidental adrenal mass
1. Consider CT guided FNA if h/o of other cancer 2. Serial CT’s (6, 12, 24 mo): consider FNA if growing **Don't do an FNA if concerning for a pheo bc could cause a hypertensive crisis
78
tx of incidental adrenal mass
1. Observation 2. Surgery: - Tumor over 4-6 cm - Hormone Secreting - Concerning FNA
79
what hormones does the posterior pit. release
- Antidiuretic Hormone (ADH) | - Oxytoxicin
80
Hormone over-production disorders of the pituitary gland
Tumors: - Prolactin (prolactinoma) - FSH/LH - Growth Hormone --> Acromegaly and Gigantism - ACTH --> Cushing’s Disease - TSH --> Hyperthyroidism (very rare!)
81
Hormone under-production disorders of the pituitary gland
1. Tumors (mass effect / apoplexy) 2. Trauma 3. Infiltrative processes 4. Sheehan’s Syndrome 5. Congenital disorders
82
Etiology of hyperprolactinemia
1. Pregnancy 2. Prolactinoma 3. Hypothyroidism 4. Pituitary/Sellar Mass 5. Drugs (psych meds) 6. Kidney/Liver Failure 7. Estrogen 8. Nipple Stimulation 9. Chest wall tumors/injury 10. “Stress”
83
Signs and Sx of hyperprolactinemia
1. Hypogonadsim - Amenorrhea - Impotence/ED 2. Infertility 3. Galactorrhea* 4. Headaches 5. Visual field defects *often detected earlier in females due to amenorrhea
84
Work up of hyperprolactinemia
1. full H and P (pay attention to meds) 2. Labs - Pregnancy test** (#1 test) - TSH - CMP - Estradiol/Testosterone - LH/FSH (low) - Consider other pituitary related labs: GH, IGF-1, cortisol, TSH/FT4 3. imaging- MRI
85
goals of prolactinoma tx
1. Restoration of gonadal function - Estrogen for women - Testosterone for men 2. Fertility 3. Mass effect
86
tx for prolactinoma
1. Medical therapy: Dopamine agonists: bromocriptine, cabergoline - HRT: OCPs in premenopausal women testosterone in men 2. surgery
87
why do we care about incidental pituitary masses, and what do we do next to assess
1. Hormone secreting? 2. hypopituitarism? 3. Mass effect? - screen for hormone dysfunction (subclinical) - screen for mass effect-- visual field testing
88
when screening for hormone dysfunction in an incidental pituitary mass what are you looking for?
1. Cortisol: LDDST/24-hr UFC (vs Cort Stim) 2. Acromegaly: GH, IGF-1 3. Prolactinoma: PRL 4. Sex Steroids: LH, FSH, Estradiol/Testosterone 5. Thyroid: T4 6. Non-Secreting: alpha-subunit 7. Diabetes Insipidus
89
tx for hormone hypersecretion with an incidental pituitary mass
Appropriate medical (prolactinoma) vs. surgical therapy
90
tx for hypopituitarism with an incidental pituitary mass
hormone replacement +/- sugery
91
tx for mass effect with an incidental pituitary mass
consider surgery (unless prolactinoma)
92
tx for an incidental pituitary mass w/ no hormone dysfunction or mass effect
- Observation | - Consider repeat imaging in 6-12 months
93
hormone replacement therapy for hypogonadism
- Testosterone in men | - Estrogen +/- progesterone in women
94
panhypopituitarism conditions
1. hypogonadism 2. hypothyroidims 3. adrenal insufficiency 4. growth hormone deficiency 5. diabetes inspidus
95
hormone replacement therapy for hypothyroidism
- Levothyroxine | - Follow FT4 not TSH, aim for high-normal FT4
96
hormone replacement therapy for adrenal insufficiency
prednisone 4-5mg daily
97
hormone replacement therapy for growth hormone deficiency
daily injection, very expensive
98
hormone replacement therapy for diabetes inspidius
ddAVP intranasally as needed to control polyuria
99
Labs for primary adrenal insufficiency
``` K high Na low BUN/Cr high CRH high ACTH high Testosterone, aldosterone and cortisol low ```
100
ddx for adrenal insuffiecieny
infection/spesis | polynephritis
101
what is sheehan's syndrome
postpartum hypopituitarism or postpartum pituitary gland necrosis, is hypopituitarism (decreased functioning of the pituitary gland), caused by ischemic necrosis due to blood loss and hypovolemic shock during and after childbirth *often causes secondary adrenal insufficiency
102
symptoms of sheehan's syndrome
- difficulty breastfeeding - hypotension - fatigue - irregular heart beat - no period *often causes secondary AI
103
how long does it take to develop Cushing's syndrome
-typically months to years unless its an ectopic ACTH secreting tumor
104
classic triad of sx for pheochromocytoma
HA, sweating (w/o flushing), palpitations *probably hypertensive during these spells
105
what do ACE meds (ex. lisinopril) do to K+?
boost it a little *so someone with borderline low K+ (3.8) on lisinopril might actually have lower K
106
FNA of a pheo could cause what
hypertensive crisis
107
what is the "master" gland
pituitary gland
108
ddx of hyperprolactinemia
pregnancy | hypothyroidism
109
what hormone do you not replace w/ panhypopituitarism
prolactin

Adult Clinical Medicine (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions