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DEMS: Unit III > Adrenal Disorders > Flashcards

Adrenal Disorders Flashcards

1
Q

Causes of primary adrenal insufficiency

A 
Autoimmune: Addison's
infectious: TB, FUngi. HIV
Infiltrative: Amyloid
Hemorrhage
Metastatic
Metabolic
Surgery
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2
Q

Unique findings in primary adrenal insufficincy

A

Vitiligo
pigmintation
hyperkalemia

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3
Q

Lab findings in Primary adrenal insufficincy

A 
Hyperkalemia 
Low serum cortisol 
High serum ACTH
Small on CT: metabolic/autoimmune
Big on CT: all other
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4
Q

Agent used in ACTH stimulation test

A

cpsyntropin (synthetic ACTH)

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5
Q

Components of Autoimmune Polyglandular Syndromes (APS-1)

A

Adrenal Insufficiency
hypoparathyroidism
DM1
mucocutanous candidiasis

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6
Q

Components of Autoimmune Polyglandular Syndromes (APS-2)

A

Adrenal Insufficiency
hypothyroidism
DM1

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7
Q

Causes of secondary adrenal insufficiency

A

-Glucocorticoids (most common)
-opioids
-tumor
-surgery
Problem with Hypothalamic CRH or pituitary ACTH

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8
Q

LAb findings in secondary adrenal insufficiency

A
  • Low serum cortisol
  • Cosyntropin stimulation test accurate if AI>3 weeks
  • normal or low ACTH
  • You want to image the pituitary not the adrenalgland
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9
Q

Adrenal insufficiency Tx

A
  • Primary or secondary: Glucocorticid replacement

- Primary only: Mineralocorticoid replacement

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10
Q

Subtypes of primary aldosteronism

A 
Aldosterone producing adenoma (APA)
Idiopathic Hyperaldosteronism (IHA) ( more common)
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11
Q

Sx of primary aldosteronism

A

Hypertension
Hypokalemia
Metabolic Alkolosis

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12
Q

Who to screen for primary aldosternoism

A

hypokalemia (provoked w/ diurtics or spontaneous)

-Hypertension

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13
Q

Labs for Primary aldosternoism

A

Morning sample:
-Plasma aldosterone
-Plasma Renin Activity
Run confirmation tests for a positive screen (try to supress aldosterone)
-Sodium supression testing (oral salt load or IV saline infusion)
Diagnostic results:
-Oral salt load (24 hr urine aldosterone >12
-IV saline (PA>10)

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14
Q

Best imaging tests for adrenal

A

CT (best)

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15
Q

Imaging of adrenal hyperplasia vs adenoma

A 
Hyperplasia 
-enlarged
-same shape
-can be multinodular
Adenoma
-oval mass
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16
Q

Explain NP-59 adrenaocortical scintigraphy

A

NP-59: cholesterol analog -binds to adrenal LDL
receptors (cholesterol is base for steroid hormones)
-Adenoma:Unilateral Visualization
-Hyperplasia:Bilateral Visualization Sensitivity: 50-100%

17
Q

APA is llikely found in pts w/

A 
Age <40
Severe HTN
Severe Hypokalemia
High PA
High urine aldosterone
18
Q

APA Tx

A

Pre-op: Aldosterone antagonists

  • Spironolactone
  • `Eplerenone

THEN
operate: laproscopic/open

19
Q

Pheochromocytoma Sx (triad)

A

-Hypertension Plus
-Headaches,
-Sweating,
-Palpitations
Prevalence is low (1/1,000-10,000 of HTN pts)

20
Q

Rule of 10’s pheochromocytoma

A

10% Malignant
10% Familial
10% Bilateral
10% extra-adrenal

21
Q

Pheocromocytome familial disease

A

Multiple Endocrine Neoplasia Type 2A/2B
Von Hippel Lindau Syndrome
Neurofibromatosis Type 1
Familial Paragangliomas (SDH Mutations)

22
Q

Pheochromocytoma screening tests

A 
Urine metanephrins (best fr screening)
urine catecholamines (best for screening)
plasma metanephrines (use for pts w/ high pretest probability)
23
Q

Pheochromocytoma radiology

A

spherical, well circumscribed

variable features on CT

24
Q

Organ of Zuckerkand

A

Sympathetic chain ganglia at the aortic bifurcation

25
Q

Pre-op management of pheochromocytoma

A 
Alpha blockers (1st)
Beta blockers (2nd-after alpha blockade)
CCB (alone)\

then take it out

26
Q

T or F: 80% of cushing syndrome is caused by ACTH secreting tumor

A

True

27
Q

T or F: 10% of Cushing’s is caused by cortisol secreting adrenal tumor

A

True, the other 10% is ectopic ACTH secreting tumor.

28
Q

Cushing’s presentation

A

Santa Clause (Sx covered in other lectures)

29
Q

Screening for Cushing’s

A

24 Hr urine cortisol (elevated)
1 mg dexamethazone supression test (DST)
Bedtime salivary cortisol (elevated)

30
Q

Conditions with hypercortisolism but NOT cushings

A 
Pregnancy 
Depression 
Alcoholism 
\Morbid Obesity 
Diabetes Mellitus, Poorly Controlled
31
Q

Tests to localize Cushing’s cause

A

Pituitary MRI
Chest CT
Abdominal CT
Inferior Petrosal Sinus Sampling

32
Q

Cushing’s Tx

A
  • Surgery:
  • ACTH Secretion Inhibitors: Cabergoline, Pasireotide -Cortisol Synthesis Inhibitors: Ketoconazole, Metyrapone, Etomidate
  • Adrenolytic Agents: Mitotane
  • Cortisol Receptor Blockers: Mefispristone
33
Q

What are adrenal incidentaloma

A

Incidental finding of adrenal tumor (frequent finding)
Usually benign
usually non-functional (bu some secrete unregulated cortisol)

34
Q

Evaluation of incidentalomas

A

Determine cancer risk

determine if hormonally active

35
Q

Management of incidentalomas

A 
Surgical Removal
-Size >4.5 cm
-Progressive Growth
-Hormone Secretion
Monitor (6 mos, 12 mos, 24 mos)
-Size < 4.5 cm
-No Hormone Secretion

DEMS: Unit III (21 decks)

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