adrenal diseases Flashcards
What would you think if a female patient presents with hypertension, central obesity and purple striae?
Cushings
What is the most common screening tool for cushings?
1mg overnight dexamethasone suppression test– 1 mg dex at 11PM, 8AM cortisol level- <2mcg/dl is normal
What are two other screening tests for cortisol?
24 hour urine free cortisol level
Midnight salivary cortisol level
What do you think when you see hypertension with hypokalemia?
hyperaldosteronism
What are the two etiologies of hyperaldosteronism?
adenoma or bilat hyperplasia
What is a positive screening test for hyperaldosteronism?
aldosterone/renin ratio >30 with pt not taking diuretics, beta blockers, nifedipine
What are the two localizing tests used to identify the cause of hyperaldosteronism?
CT scan- sensitive but not specific since nodules are common in patients >40 years old Bilateral adrenal vein sampling- aldo/cort Iodocholesterol scans
What are the treatments for hyperaldosteronism?
Surgical– laparoscopic adrenalectomy Medical– spironolactone, amiloride, epleronone
Side note: spironolactone causes gynecomastia
Hypertension with abdominal bruit?
renal artery stenosis
what does renal artery stenosis lead to?
secondary hyperaldosteronism
In secondary hyperaldosteronism, is renin high or low?
high! As opposed to primary where it is low compared to aldosterone (30:1)
Hypertension with Headaches, Sweats, and Palpitations?
pheochromocytoma
are a-receptors more sensitive to norepi or epi? What does this cause internally?
NE > Epi
Arteriolar constriction
Sweating
are b-receptors more sensitive to norepi or epi? What does this cause internally?
EPI > Norepi
Arteriolar dilatation
increased contractility / rate
increased BG (blood glucose)
What will you see in more than 98% of people with pheochromocytoma?
a change in blood pressure….could be in the form of the following:
Sustained HTN
Paroxysmal HTN
Orthostatic change
Paradoxal change in BP:from b-blockers, anesthesia
what are some other signs?
Tachycardia / Arrhythmia / CHF / Shock
Facial pallor / tremor
what is the most common screening test for pheochromocytoma?
24 hour urine catechols, . metanephrines, or VMA
What are two other screening tests?
Plasma fractionated metanephrine
Clonidine suppresion test
what are localizing tests for pheochromocytoma?
MRI (best) or CT
MIBG Scan- nuclear medicine test
What do you administer pre-op for pheochromocytoma?
Selective a1 –blockade: Doxazosin & Prazosin
Less reflex tachycardia
Shorter T½
Less postoperative hypotension
What is the most common cause of Addison’s disease? other causes?
autoimmune disorder- most common but still very rare
Tuberculosis
HIV, CMV
Ketoconazole rx
Adrenal hemorrhage– heparin, meningococcemia
In Addison’s disease, of the following, which will increase and which will decrease? Cortisol, ACTH, aldosterone, K+, Na+, b.p.
cortisol (dec.) ACTH (inc.) aldosterone (dec.) K+ (inc.) Na+ (dec.) b.p. (dec.)
what are some other autoimmune diseases seen with Addison’s disease?
vitiligo, hypothyroidism, pernicious anemia, type 1 diabetes, hypoparathyroidism
What test is used to diagnose Addison’s disease?
Cortrosyn stimulation test—to test how well adrenals respond to ACTH administration. subnormal cortisol level at 30 minutes («18 mcg/dl
