Adrenal Disorders Flashcards
Primary adrenal insufficiency results in loss of _________.
cortisol and aldosterone secretion
Secondary adrenal insufficiency results in loss of _____________.
cortisol only (aldosterone is preserved because it’s controlled by angiotensin II)
_____________ is also called autoimmune adrenalitis.
Addison’s disease
What five drugs can cause adrenal insufficiency?
Aminoglutethimide Ketoconazole Etomidate Rifampin Phenytoin
The most common cause of primary adrenal insufficiency is ____________ and secondary adrenal insufficiency is _____________.
Addison’s disease; steroid use
Salt craving is a symptom of ___________ adrenal insufficiency.
primary (because aldosterone secretion is preserved in secondary adrenal insufficiency)
Adrenal crisis should be treated with ____________.
stress-dose steroids (100 mg every eight hours)
What three signs and symptoms occur only in primary adrenal insufficiency (as opposed to secondary)?
Hypotension
Hyperkalemia
Hyponatremia
Why does hyperpigmentation occur in primary adrenal insufficiency?
Because melanocyte-stimulating hormone and proopiomelanocortin are both breakdown products of POMC. If POMC is not broken down by the adrenal gland, then more is available to the melanocytes.
Half of the people with Addison’s disease have at least _________________.
one other autoimmune disease
What cortisol levels –taken around 7 - 8 AM –suggest adrenal insufficiency?
Partial: 5 - 16 mg/dL
Complete: less than 5 mg/dL
If a person has suspiciously low cortisol levels, what should you do?
A cosyntropin test; less than 20 mg/dL 30-60 minutes after administration suggests adrenal insufficiency
In primary adrenal insufficiency, you need to replace ______________, while in secondary adrenal insufficiency you only need to replace ___________.
both glucocorticoids and mineralocorticoids; glucocorticoids
What is AVS?
Adrenal vein sampling
Licorice intake can lead to _______________.
pseudohypercortisolism
Plasma metanephrines should be drawn after ______________.
twenty minutes’ rest
The vast majority of adrenal incidentalomas are ______________.
non-functional
Cortisol is necessary for ____________ balance.
cardiovascular (in adrenal insufficiency, people get hypovolemia and hypotension)
The most common cause of primary adrenal insufficiency in the U.S. is ___________, while worldwide it is ______________.
Addison’s (autoimmune destruction); TB
The best way to diagnose adrenal insufficiency is _____________.
Cortrosyn stimulation; you measure cortisol 30 minutes and 60 minutes after administering Cortrosyn (synthetic ACTH). Levels greater than 20 ug/dl indicate adequacy of adrenal reserves
The most common cause of primary hyperaldosteronism is ___________, followed by _____________.
idiopathic; adrenal adenoma
These clinical signs should raise suspicion for primary hyperaldosteronism: _______________.
treatment-refractory hypertension, hypokalemia, and young age at onset
The best diagnostic for primary hyperaldosteronism is a ___________ test.
aldosterone suppression (in which saline is given and then aldosterone levels measured)
What differentiates MEN 2A and MEN 2B?
Both are mutations in the ret gene and present with pheochromocytoma and medullary thyroid carcinoma, but 2A presents with hyperparathyroidism (which has two A’s) while 2B presents with mucosal neuromas.
What triad of symptoms does pheochromocytoma present with?
Diaphoresis, palpitations, and headaches
The preferred lab test for diagnosing pheochromocytoma is _______________.
24-hour urine metanephrines
The most common cause of Cushing’s is iatrogenic, but the second most common cause is ________________.
ACTH-secreting adenoma
________________ is also called Conn’s syndrome.
Primary hyperaldosteronism
Why does licorice cause pseudohyperaldosteronism?
Licorice inhibits the enzyme that converts cortisol to cortisone, thereby raising the levels of cortisol. This binds to the aldosterone receptor and leads to similar symptoms of high aldosterone levels.
Metyrapone is a __________________.
cortisol synthesis inhibitor
What can affect metanephrine level?
Acetaminophen, SSRIs, marijuana, and SNRIs
In addition to metanephrines, ______________ is another good lab indicator of pheochromocytoma.
vanillylmandelic acid
About half of pheochromocytomas are __________.
hereditary (more if the presentation occurs in childhood)
Which chromosome does the Ret gene lie on?
10 (MEN = ten)
What is a good way on imaging to predict an adrenal adenoma’s prognosis?
Houndsfield units: less than 10 is suggestive of benign
