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Clinical medicine A > adrenal disorders triggers > Flashcards

adrenal disorders triggers Flashcards

1
Q

secretes EPI and NE

A

adrenal medulla

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2
Q

Cortisol deficiency
Aldosterone deficiency
Androgen excess

what enzyme deficicency

A

21A-2

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3
Q

Excess Aldosterone, deficient in everything else.

what enzyme def

A

17A1

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4
Q

excess cholesterool decreased everything else

what enzyme def

A

11A1

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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

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6
Q

stimulates gluconeogenesis in the liver

A

cortisol

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7
Q

mitotaine

A

drug that can cause addisons

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8
Q

anticoagulants, trauma, surgery, HIT, sepsis, APS

A

causes of adrenal hemorrhage

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9
Q

insufficient cortisol

A

Addisons and CAH

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10
Q

congenital adrenal insufficiency /hyperplasia

A

addisons

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11
Q

Hyponatremia, hyperkalemia

A

addisons

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12
Q

hypotension, High fever, renal shut down

A

addisonian crisis

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13
Q

bronze pigmentation of skin

A

could be either addisons or cushings

cushings considered “hyperpigmentation”

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14
Q

hypoglycemia

A

addisons

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15
Q

changes in distribution of body hair with postural hypotension

A

addisons

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16
Q

vitiligo

A

addisons

d/t immune system attacking melanin cells

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17
Q

lymph tissue hyperplasia

A

addisons
d/t increased immune response

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18
Q

generalized pain/aches

A

addisons d/t incresed inflammation

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19
Q

high fever

A

addisinian crisis

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20
Q

could present as appendicitis since acute abdominal symptoms w/possible NVD

A

addisonian crisis

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21
Q

eosinophilia and lymphocytosis

A

addisons

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22
Q

leukocytosis with low eosinophils, neutrophilia, lymphocytopenia

A

cushings

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23
Q

elevated BUN/Cr and hypoglycemia

A

addisons

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24
Q

low cortisol and high ACTH

A

addisons

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25
Q

random cortisol <25

A

addisons

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26
Q

random cortisol >25

A

rules out addisons

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27
Q

ACTH stimulation test

A

addisons

positive if rise is <20

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28
Q

increased plasma renin

A

addisons

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29
Q

CT shows small adrenal glands w/o calcification.

be SPECIFIC what does this suggest

A

autoimmune addisons

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30
Q

2/3 in morning and 1/3 at night dosing

A

addisons w/ hydrocortisone

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31
Q

glucocorticoid stress thereapy

A

addisons

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32
Q

fludrocortisone

A

addison’s treatment used in pts who are on low doses of hydrocortisone

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33
Q

benign anterior pituitary adenoma

A

MCC cushings syndrome

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34
Q

ACTH independent hypercortisolism

A

cushings SYNDROME

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35
Q

ACTH dependent hypercortisolism

A

cushings DISEASE

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36
Q

easy bruising

A

cushings

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37
Q

hyperglycemia

A

cushings

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38
Q

hypernatremia, hypokalemia

A

cushings

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39
Q

antiseizure drugs, rifampin, and estrogens

A

can cause false negatives in dexamethasone suppression test

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40
Q

dexamethasone supp test of 6 mcg

A

positive

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41
Q

dexamethasone supp test of 4

A

rules OUT cushings

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42
Q

what is considered positive on late night salivary

A

readings OVER 100.

indicative of cushings

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43
Q

low ACTH + high cortisol

A

suggestst adrenal tumor

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44
Q

High ACTH + high cortisol

A

suggests source making ACTH

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45
Q

metryapone and osilodrostat

A

decline sugery or awaiting surgery for: adrenal adenoma or carcinoma

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46
Q

what are the 11-Bhydroxylase inhibitors

A

metryapone and osilodrostat

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47
Q

pasireotide

A

pituitary tumor awating or refusing surgery

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48
Q

spirinolactone, eplerenon

A

used for mineralcorticoid HTN

49
Q

flutamide

A

used in hyperandrogenism for women who develope male characteristic

50
Q

inferior petrosal sinus sampling

A

used in pituitary adenomas if MRI shows lesion <5mm or if no lesion is seen

51
Q

plasma renin

A

ordered in addisons to monitor treatment

52
Q

clitoral enlargment, labial fusion, formation of urogential sinus

A

classic virilizing adrenal hyperplasia in females

53
Q

precocious puberty accelerated growth and early skeletal maturation

A

simple virilizing adrenal hyperplasia

54
Q

oligomenorrhea, hirstiusm, infertility

A

nonclassic adrenal hyperplasia

55
Q

hyperpigmented scrotum, enlarged phallus with failure to thrive

A

salt-wasting CAH in males

56
Q

pubic hair and adult body odor @ 2-4 yrs of age

A

simple virilizing adrenal hyperplasia

also presents w accelerated linear growth and skeletal maturation

57
Q

Ambiguous genitalia or female genitalia due to the inadequate testosterone production.

A

CAH with:
StAR protein
HSDB2 deficiency
CYP17A deficiency

58
Q

autosomal recessive

A

CAH

59
Q

imaging used for ambiguous genitalia in CAH

A

pelvic US

60
Q

imaging used for non-ambiguous genitalia in CAH

A

CT abdomen

61
Q

treatment for CAH

A

Hydrocortisone treatment with initial dosing and then tapering down to daily maintenance dose.

Fludrocortisone daily

62
Q

adrenal vein sampling

A

hyperaldosteronism

Indicated only if severely uncontrolled HTN + adrenalectomy is being considered for tx. Determines which gland is hyperactive.

63
Q

treat w low sodium diet

A

hyperaldosteronism

64
Q

Treat w ACE inhib, ARB, CCP, and K+ sparing diuretics

A

hyperaldosteronism

65
Q

hydrocortisone and flucortisone daily

A

CAH

66
Q

tumor secreting Epi and NE

A

pheochromocytoma

67
Q

comes from the sympathetic paraganglia

A

pheochromocytoma

68
Q

average age of onset = 40, commonly associated w HTN

A

pheochromocytoma

69
Q

Episodic palpitations
HA
Profuse diaphoresis

A

classic triad for pheochromocytoma

70
Q

plasma free metanephrines

A

pheochromocytoma

71
Q

hypernatremia, hypokalemia, elevated CO2

A

hyperaldosteronism

72
Q

goal BP of <160/90 prior to surgery

A

pheochromocytoma

73
Q

HTN Crisis
Cardiac arrhythmias
CVA
MI

A

4 main complications w pheochromocytoma

74
Q

what disease is related to the glomerulosa

A

primary aldosteronism

75
Q

what disease is related to fasciculata

A

cushings disease

76
Q

what disease related to adrenal medulla specifically

A

pheochromocytoma

77
Q

children living in southern brazil

A

risk for developing adrenal carcinoma

78
Q

Palpable, firm, adherent mass of the abdomen.

A

adrenal carcinoma

79
Q

CT abdomen and pelvis with contrast

A

suspected adrenal carcinoma work up or workup for pheochromocytoma

80
Q

What medications can affect PRA/PAC lab results?

A

RAAS system inhibitors
Slow-release verapamil, hydralazine, terazosin, doxazosin

81
Q

why not do FNA in a person w pheochromocytoma

A

will place pt in HTN crisis

82
Q

what is the long acting glucocorticoid

A

dexamethasone

83
Q

what is the short acting glucocorticoid

A

hydrocortisone

84
Q

pt cant swallow well, what glucocorticoid can they have

A

prednisolone because its in syrup formation

85
Q

alpha andrenergic blockers such as the “zosins” as well as a high salt and water intake are used for what

A

preparation for pheochromocytoma surgery.

also a BP of <160/90

86
Q

Describe the difference between primary, secondary and tertiary adrenal insufficiency

A

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
Q

what age would you suspect addisons to present in

A

10-40

88
Q

lymph tissue hyperplasia

A

addisons

89
Q

Low ACTH + high cortisol

A

adrenal tumor (cushings)

90
Q

High ACTH + High cortisol

A

source making ACTH

91
Q

red flags for a malignant carcinoma of the adrenal gland

A
  1. > 4cm
  2. Growth of nodule (if previous CT)
  3. Density > 10 Hounsfield Units
92
Q

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

A

this is a negative test since late night salivary cortisol must be over 100 on both occasions to be positive.

93
Q

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

A

this is a negative test since late night salivary cortisol must be over 100 on both occasions to be positive.

94
Q

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

A

this is a positive test since late night salivary cortisol must be over 100 on both occasions to be positive.

95
Q

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

A

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
Q

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

A

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
Q

when is rapid ACTH testing indicated in Addison’s disease

A

if plasma cortisol and plasma ACTH are non-diagnostic.

98
Q

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

A

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
Q

if a patients come in with symptoms indicating cushings syndrome/disease. what is the order of the workup that will be completed

A

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
Q

MOA of ketoconazole

A

inhibits early steps of steroidogenesis

101
Q

awaiting surgery for a pituitary tumor, what drug can they take

A

pasireotide

102
Q

pasireotide MOA

A

somatostatin analog that inhibits ACTH secretion

103
Q

DOC for mineralocorticoid HTN

A

Spironolactone or eplerenone

ACE inhibitor second line

104
Q

MOA of flutamide

A

inhibits androgen uptake in females w hyperandrogenism

105
Q

what is the interpretation of a serum ACTH

A

<20 = adrenal CT
>20 = pituitary MRI

106
Q

What kind of CT abdomen finding suggests autoimmune addison’s

A

Small without calcifications on adrenal gland.

107
Q

what is the workup in order for someone who is presenting with symptoms consistent w CAH

A

CBC/CMP (or BMP) (look for symptoms associated to aldosterone deficiency)

Imaging is not necessary unless youre attempting to rule out other diagnoses

108
Q

when would you order a CT in a work up for CAH

A

to rule out bilateral adrenal hemorrhage ( only in patients without ambiguous genitalia)

109
Q

when is pelvic US used in the workup for CAH

A

assessing organic anomalies associated w ambiguous genitalia to look for renal anomalies, female sex organ abnormalities

110
Q

conn syndrome and malignant carcinomas

A

two types of aldosterone producing tumors

111
Q

when would you see an increased bicarbonate level

A

primary hyperaldosteronism

112
Q

elevation of 17-hydroxyprogesterone and DHEA

A

21-hydroxylase deficiency CAH

113
Q

these labs should be drawn out of bed for 2+ hours + seated for 15-60 minutes prior to blood draw

A

PRA/PAC for testing in primary hyperaldosteronism

114
Q

RAAS system inhibitors affect what

A

PAC/PRA lab results

115
Q

potassium sparing diuretics

A

primary aldosteronism

116
Q

low sodium diet as treatment

A

primary aldosteronism

117
Q

HTN from young age w no risk factors

A

primary hyperaldosteronism

118
Q

avg age onset = 40
HTN is most associated dx

A

pheochromocytoma

119
Q

plasma free metanephrines

A

pheochromocytoma

Clinical medicine A (32 decks)

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