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Clin Med 2 > Adrenal Gland > Flashcards

Adrenal Gland Flashcards

1
Q

What is the most common cause of ACTH-dependent Cushing’s syndrome?

A

Pituitary adenoma

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2
Q

What are some important causes of ACTH-independent Cushing’s syndrome? (excess cortisol)

A

Adrenal tumor (nodular hyperplasia)
Neuroendrocrine tumors (ie: MEN I, Zollinger Ellison
Syndrome)
Pheochromocytoma

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3
Q

What is the initial test for Cushing’s disease? The gold standard?

A

Dexamethasone suppression test; 24 hr urine free cortisol

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4
Q

When do you perform a salivary sample looking for Cushing’s? What result are you expecting for Cushing’s? What can skew the results?

A

11:00 PM 3 nights in a row; it will be high; high stress and heavy exercise prior to tests

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5
Q

What is considered first line treatment for Cushing’s disease?

A

Surgery to remove adrenal or pituitary tumor

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6
Q

What is the most common cause of primary adrenal insufficiency? Secondary?

A

Acute/chronic destruction due to autoimmune abs; Quick cessation of steroid

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7
Q

What is the hallmark triad of Addison’s disease?

A

Weakness, weight loss/anorexia, hyperpigmentation, hypotension

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8
Q

What is the gold standard test of adrenal insufficiency?

A

cosynotropin stim test

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9
Q

Which salivary sampling test evaluates for Addison’s?

A

Morning salivary x 3 days

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10
Q

What are three important findings on a CMP in Addison’s?

A

HyperK+, HyperCa+, HypoNa+

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11
Q

What are important findings in Addison’s on a CBC?

A

Anemia and eosinophilia

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12
Q

What infectious processes do you need to rule out in an adrenal insufficiency workup?

A

Cocci and TB

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13
Q

What other hormone levels should be checked with adrenal insufficiency?

A

TSH, LH, prolactin, and FSH

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14
Q

What scans for adrenal insufficiency should be done?

A

CT of adrenals, MRI of pituitary

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15
Q

What is the most common cause of primary hyperaldosteronism?

A

adrenocortical adenoma

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16
Q

What are sx of Conn’s syndrome?

A

HTN, Low K+, weakness, HA, etc.

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17
Q

What are labs for Conn’s syndrome?

A

Elevated plasma and urine aldosterone
Low plasma renin levels
Ct scan of adrenals to evaluate for adrenal
adenoma

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18
Q

What are classic signs of pheo?

A

Paroxysmal anxiety attacks, SEVERE HTN, HA

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19
Q

Besides a plasma and urine catecholamine check, what other test is important to check for pheo?

A

CLONIDINE SUPRESSION TEST

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20
Q

How do you tx a pheo crisis?

A

IV nitroprusside

21
Q

How do you prep pheo for surgery?

A

alpha and beta blockers

22
Q

What labs should you run looking for sellar masses and you are concerned about hypersecretion?

A

Prolactin, IFG-1, GH, TSH, Cortisol, ACTH

23
Q

What is the typical cause of hyposecretion? What if you are concerned with hyposecretion?

A

USUALLY a hypothalmic or pituitary lesion, not and adenoma; Same and hyper but include FSH/LH, testosterone, estradiol, ADH

24
Q

What is the standard imaging for sellar mass? What about calcification?

A

MRI of sella; CT is better for calcification

25
Q

When do prolactin levels peak?

A

during REM sleep and in AM

26
Q

What are signs and sxs of excess prolactin?

A

visual, HA, thyroid probs

27
Q

What is the treatment for excess prolactin?

A

Dopamine agonist BROMOCRIPTINE

28
Q

What is a surgical tx for excess prolactin? What is to be watched for post op?

A

Transphenoidal resection; SIADH

29
Q

What should a w/u for acromegaly include?

A

Full hormone; HYPERCALCIURIA is common

MRI of brain should be the initial study.

30
Q

If serum GH/IGF levels are high, what should be done to evaluate cause? What is a positive test?

A

Suprression test/2 hr glucose test; GH remaining high after glucose admin

31
Q

What are two treatments for GH increase?

A 
somatostatin analogues (octreodide and lanreotide)
GH RECEPTOR AGONISTS (pegvisomant)
32
Q

What is the most effective method for rapid GH reduction?

A

surgery

33
Q

What is the test of choice for adult-onset GH deficiency?

A

Arginine-growth hormone-releasing hormone

34
Q

How do you treat adult-onset GH deficiency?

A

DON’T TX unless you know cause, MOST DON’T NEED TX! Use recomb GH

35
Q

Hypopit due to inflammation causes deficiency in which hormones?

A

GH, GnRH, AVP

36
Q

Hypopit due to infection causes deficiency in which hormones?

A

can be all or just a few

37
Q

What is the cause of Sheehan’s syndrome?

A

Post-partum blood loss, pan-hypotituitarism

38
Q

Labs of DI

A

High osmolarity of plasma, low osmolarity of urine, dehydration

39
Q

Labs of SIADH

A

High osmol of urine, low osmol of plasma

40
Q

What drugs can increase cortisol levels?

A

estrogen (PREGNANCY), amphetamines, prednisone, spiro

41
Q

What drugs can decrease cortisol?

A

androgens, lithium, levodopa

42
Q

What is considered a below normal test result on a cosynopropin stimulation test?

A

a rise in cortisol of <7 above baseline

43
Q

ROCH

For bilateral adrenal hyperplasia (Cushings), what should a prolonged dex test show? Rapid plasma?

A

50% reduction of plasma cortisol and urine 17-OCHS levels; No change in cortisol

44
Q

What do you use for imaging adrenals? What is the most accurate?

A

CT; MRI

45
Q

High serum prolactin can have which effects?

A

Can suppress GnRH and FSH production hypogandism, amenorrhea

Can overstimulate mammary glands galactorrhea/gynecomastia due to engorgement

46
Q

In which diseases should you consider a prolactin workup?

A 
–Amenorrhea or Dysfunctional uterine bleeding
–Hypogonadism
–Infertility
–Hypothyroid
–Adrenal disease
–Galactorrhea
–Low libido/sexual or erectile dysfunction
–Vision loss or changes/headaches
–Epilespy/Seizure disorder
–Pituitary mass
47
Q

Stimulators of GH release

A 
–Growth hormone releasing hormone (GHRH)
–Sleep
–Exercise
–Hypoglycemia
–Dietary protein
–Estradiol
–Arginine
48
Q

Inhibitors of GH release

A

–Somatostatin from the periventricular nucleus
–Circulating concentrations of GH and IGF-1 (negative feedback)
–Dietary carbohydrate
–Glucocorticoids

49
Q

What study is used to evaluate the pituitary? When is a micro and macroadenoma considered?

A

MRI; micro 1 cm

Clin Med 2 (13 decks)

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