adrenal disorders triggers Flashcards
1
Q
secretes EPI and NE
A
adrenal medulla
2
Q
Cortisol deficiency
Aldosterone deficiency
Androgen excess
what enzyme deficicency
A
21A-2
3
Q
Excess Aldosterone, deficient in everything else.
what enzyme def
A
17A1
4
Q
excess cholesterool decreased everything else
what enzyme def
A
11A1
5
Q
Accumulation of long chain fatty acids in adrenal cortex causing inhibited effects of ACTH
A
adrenoleukodystrophy
one etiolgy of addisons
inhibits ACTH effects
6
Q
stimulates gluconeogenesis in the liver
A
cortisol
7
Q
mitotaine
A
drug that can cause addisons
8
Q
anticoagulants, trauma, surgery, HIT, sepsis, APS
A
causes of adrenal hemorrhage
9
Q
insufficient cortisol
A
Addisons and CAH
10
Q
congenital adrenal insufficiency /hyperplasia
A
addisons
11
Q
Hyponatremia, hyperkalemia
A
addisons
12
Q
hypotension, High fever, renal shut down
A
addisonian crisis
13
Q
bronze pigmentation of skin
A
could be either addisons or cushings
cushings considered “hyperpigmentation”
14
Q
hypoglycemia
A
addisons
15
Q
changes in distribution of body hair with postural hypotension
A
addisons
16
Q
vitiligo
A
addisons
d/t immune system attacking melanin cells
17
Q
lymph tissue hyperplasia
A
addisons
d/t increased immune response
18
Q
generalized pain/aches
A
addisons d/t incresed inflammation
19
Q
high fever
A
addisinian crisis
20
Q
could present as appendicitis since acute abdominal symptoms w/possible NVD
A
addisonian crisis
21
Q
eosinophilia and lymphocytosis
A
addisons
22
Q
leukocytosis with low eosinophils, neutrophilia, lymphocytopenia
A
cushings
23
Q
elevated BUN/Cr and hypoglycemia
A
addisons
24
Q
low cortisol and high ACTH
A
addisons
25
random cortisol <25
addisons
26
random cortisol >25
rules out addisons
27
ACTH stimulation test
addisons
positive if rise is <20
28
increased plasma renin
addisons
29
CT shows small adrenal glands w/o calcification.
be SPECIFIC what does this suggest
autoimmune addisons
30
2/3 in morning and 1/3 at night dosing
addisons w/ hydrocortisone
31
glucocorticoid stress thereapy
addisons
32
fludrocortisone
addison's treatment used in pts who are on low doses of hydrocortisone
33
benign anterior pituitary adenoma
MCC cushings syndrome
34
ACTH independent hypercortisolism
cushings SYNDROME
35
ACTH dependent hypercortisolism
cushings DISEASE
36
easy bruising
cushings
37
hyperglycemia
cushings
38
hypernatremia, hypokalemia
cushings
39
antiseizure drugs, rifampin, and estrogens
can cause false negatives in dexamethasone suppression test
40
dexamethasone supp test of 6 mcg
positive
41
dexamethasone supp test of 4
rules OUT cushings
42
what is considered positive on late night salivary
readings OVER 100.
indicative of cushings
43
low ACTH + high cortisol
suggestst adrenal tumor
44
High ACTH + high cortisol
suggests source making ACTH
45
metryapone and osilodrostat
decline sugery or awaiting surgery for: adrenal adenoma or carcinoma
46
what are the 11-Bhydroxylase inhibitors
metryapone and osilodrostat
47
pasireotide
pituitary tumor awating or refusing surgery
48
spirinolactone, eplerenon
used for mineralcorticoid HTN
49
flutamide
used in hyperandrogenism for women who develope male characteristic
50
inferior petrosal sinus sampling
used in pituitary adenomas if MRI shows lesion <5mm or if no lesion is seen
51
plasma renin
ordered in addisons to monitor treatment
52
clitoral enlargment, labial fusion, formation of urogential sinus
classic virilizing adrenal hyperplasia in females
53
precocious puberty accelerated growth and early skeletal maturation
simple virilizing adrenal hyperplasia
54
oligomenorrhea, hirstiusm, infertility
nonclassic adrenal hyperplasia
55
hyperpigmented scrotum, enlarged phallus with failure to thrive
salt-wasting CAH in males
56
pubic hair and adult body odor @ 2-4 yrs of age
simple virilizing adrenal hyperplasia
also presents w accelerated linear growth and skeletal maturation
57
Ambiguous genitalia or female genitalia due to the inadequate testosterone production.
CAH with:
StAR protein
HSDB2 deficiency
CYP17A deficiency
58
autosomal recessive
CAH
59
imaging used for ambiguous genitalia in CAH
pelvic US
60
imaging used for non-ambiguous genitalia in CAH
CT abdomen
61
treatment for CAH
Hydrocortisone treatment with initial dosing and then tapering down to daily maintenance dose.
Fludrocortisone daily
62
adrenal vein sampling
hyperaldosteronism
Indicated only if severely uncontrolled HTN + adrenalectomy is being considered for tx. Determines which gland is hyperactive.
63
treat w low sodium diet
hyperaldosteronism
64
Treat w ACE inhib, ARB, CCP, and K+ sparing diuretics
hyperaldosteronism
65
hydrocortisone and flucortisone daily
CAH
66
tumor secreting Epi and NE
pheochromocytoma
67
comes from the sympathetic paraganglia
pheochromocytoma
68
average age of onset = 40, commonly associated w HTN
pheochromocytoma
69
Episodic palpitations
HA
Profuse diaphoresis
classic triad for pheochromocytoma
70
plasma free metanephrines
pheochromocytoma
71
hypernatremia, hypokalemia, elevated CO2
hyperaldosteronism
72
goal BP of <160/90 prior to surgery
pheochromocytoma
73
HTN Crisis
Cardiac arrhythmias
CVA
MI
4 main complications w pheochromocytoma
74
what disease is related to the glomerulosa
primary aldosteronism
75
what disease is related to fasciculata
cushings disease
76
what disease related to adrenal medulla specifically
pheochromocytoma
77
children living in southern brazil
risk for developing adrenal carcinoma
78
Palpable, firm, adherent mass of the abdomen.
adrenal carcinoma
79
CT abdomen and pelvis with contrast
suspected adrenal carcinoma work up or workup for pheochromocytoma
80
What medications can affect PRA/PAC lab results?
RAAS system inhibitors
Slow-release verapamil, hydralazine, terazosin, doxazosin
81
why not do FNA in a person w pheochromocytoma
will place pt in HTN crisis
82
what is the long acting glucocorticoid
dexamethasone
83
what is the short acting glucocorticoid
hydrocortisone
84
pt cant swallow well, what glucocorticoid can they have
prednisolone because its in syrup formation
85
alpha andrenergic blockers such as the "zosins" as well as a high salt and water intake are used for what
preparation for pheochromocytoma surgery.
also a BP of <160/90
86
Describe the difference between primary, secondary and tertiary adrenal insufficiency
primary: adrenal gland dysfunction leading to decreased cortisol and aldosterone
Secondary: pituitary gland dysfunction with decreased ACTH and cortisol
Tertiary: Hypothalamic dysfunction with decreased CRH, ACTH, and cortisol
87
what age would you suspect addisons to present in
10-40
88
lymph tissue hyperplasia
addisons
89
Low ACTH + high cortisol
adrenal tumor (cushings)
90
High ACTH + High cortisol
source making ACTH
91
red flags for a malignant carcinoma of the adrenal gland
1. > 4cm
2. Growth of nodule (if previous CT)
3. Density > 10 Hounsfield Units
92
a patient does a late night salivary cortisol and the result is 58ng, the next night it is repeated and the result is 89. what is the consensus
this is a negative test since late night salivary cortisol must be over 100 on both occasions to be positive.
93
a patient does a late night salivary cortisol and the result is 108ng, the next night it is repeated and the result is 92. what is the consensus
this is a negative test since late night salivary cortisol must be over 100 on both occasions to be positive.
94
a patient does a late night salivary cortisol and the result is 122ng, the next night it is repeated and the result is 106. what is the consensus
this is a positive test since late night salivary cortisol must be over 100 on both occasions to be positive.
95
when coming into the office a patients cortisol level is 32mcg. 45 minutes after ACTH stimulation the cortisol rises to 48. what is the indicated result of this test
this person is positive for addison's disease.
a positive rapid ACTH stimulation test is indicated by a rise in cortisol less than 20.
96
when coming into the office a patients cortisol level is 42mcg. 45 minutes after ACTH stimulation the cortisol rises to 78. what is the indicated result of this test
this is a negative test result for addison's disease.
a positive rapid ACTH stimulation test is indicated by a rise in cortisol less than 20.
97
when is rapid ACTH testing indicated in Addison's disease
if plasma cortisol and plasma ACTH are non-diagnostic.
98
what is the order in which addison's disease would be worked up if a new patient with no previous history presented to the office
CBC/CMP
Cultures of everything
Plasma cortisol (8am or random)
Plasma ACTh
Rapid ACTH stimulation test
Plasma renin (used to monitor treatment)
CXR and CT abdomen used when suspected etiologies such as TB or PNX for CXR and autoimmune addisons
99
if a patients come in with symptoms indicating cushings syndrome/disease. what is the order of the workup that will be completed
CBC/CMP
determine endogenous v exogenous.
if endogenous continue, if exogenous taper off steroids
if endogenous:
dexamethasone suppression test
24 hr urine free cortisol (2)
late night salivary cortisol (2)
if two of above are positive continue:
Serum ACTH
< 20 order Adrenal CT
>20 order pituitary MRI
if MRI shows no lesion or a lesion of <5mm then do inferior petrosal sinus sampling. if inferior petrosal sinus sampling shows normal ACTH then do a CT scan of chest/abdomen and if negative perform whole body PET scan.
If MRI shows lesion >5mm then begin treatment.
100
MOA of ketoconazole
inhibits early steps of steroidogenesis
101
awaiting surgery for a pituitary tumor, what drug can they take
pasireotide
102
pasireotide MOA
somatostatin analog that inhibits ACTH secretion
103
DOC for mineralocorticoid HTN
Spironolactone or eplerenone
ACE inhibitor second line
104
MOA of flutamide
inhibits androgen uptake in females w hyperandrogenism
105
what is the interpretation of a serum ACTH
<20 = adrenal CT
>20 = pituitary MRI
106
What kind of CT abdomen finding suggests autoimmune addison’s
Small without calcifications on adrenal gland.
107
what is the workup in order for someone who is presenting with symptoms consistent w CAH
CBC/CMP (or BMP) (look for symptoms associated to aldosterone deficiency)
Imaging is not necessary unless youre attempting to rule out other diagnoses
108
when would you order a CT in a work up for CAH
to rule out bilateral adrenal hemorrhage ( only in patients without ambiguous genitalia)
109
when is pelvic US used in the workup for CAH
assessing organic anomalies associated w ambiguous genitalia to look for renal anomalies, female sex organ abnormalities
110
conn syndrome and malignant carcinomas
two types of aldosterone producing tumors
111
when would you see an increased bicarbonate level
primary hyperaldosteronism
112
elevation of 17-hydroxyprogesterone and DHEA
21-hydroxylase deficiency CAH
113
these labs should be drawn out of bed for 2+ hours + seated for 15-60 minutes prior to blood draw
PRA/PAC for testing in primary hyperaldosteronism
114
RAAS system inhibitors affect what
PAC/PRA lab results
115
potassium sparing diuretics
primary aldosteronism
116
low sodium diet as treatment
primary aldosteronism
117
HTN from young age w no risk factors
primary hyperaldosteronism
118
avg age onset = 40
HTN is most associated dx
pheochromocytoma
119
plasma free metanephrines
pheochromocytoma
