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HRR 1 > Adrenal Gland Disorders > Flashcards

Adrenal Gland Disorders Flashcards

1
Q

Acute adrenocortical insufficiency- Eti

A
  • Emergency- insufficient cortisol
  • Addison disease
  • Stress or sudden withdrawal of adrenocortical hormone in pt with insufficiency
  • Destruction of pituitary or adrenal gland
  • Trauma
  • Etomidate administration (anesthesia)
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2
Q

Acute adrenocortical insufficiency- Sx

A
  • Lassitude (weariness), N/V/HA, abd pain
  • Confusion
  • Fever
  • Hypotension
  • Cyanosis, dehydration, skin hyper pigmentation, sparse axillary hair
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3
Q

Acute adrenocortical insufficiency- Dx

A
  • IV synthetic ACTH (Cosyntropin) test- rise in serum cortisol following admin
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4
Q

Acute adrenocortical insufficiency- Tx

A
  • Acute phase: Hydrocortisone IV

- Convalescent phase: Oral hydrocortisone

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5
Q

Chronic adrenocortical insufficiency (addison disease)- Eti

A
  • Dysfunction or absence of adrenal cortices
  • Uncommon- 4 million per year
  • Autoimmune destruction most common (80% cases)
  • Tb, sepsis
  • Type 1 in childhood, Type 2 20-40 yrs
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6
Q

Chronic adrenocortical insufficiency (addison disease)- Sx

A
  • Muscle weakness, fatigue, N/V, anorexia
  • Arthralgia, myalgia, abd pain
  • Change in skin pigmentation- hyper pigmentation over knuckles, elbows, knees, neck
  • Scant axillary & pubic hair
  • ## Longitudinal pigmented bands on nail beds
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7
Q

Chronic adrenocortical insufficiency (addison disease)- Dx

A
  • 8am plasma cortisol is diagnostic
  • Cosyntropin stimulation test
  • Anti-adrenal antibodies
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8
Q

Chronic adrenocortical insufficiency (addison disease)- Tx

A
  • Increase hydrocortisone with infections
  • Cortico & mineralocorticoid replacement tx
  • Hydrocortisone!
  • Fludrocortisine
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9
Q

Hypercortisolism/ Cushing Syndrome- Eti

A
  • Excessive corticosteroids
  • Most common due to excessive drugs, rarely due to adrenal cortex
  • Cushing disease (40%) ACTH hyper secretion by pituitary W>M
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10
Q

Hypercortisolism/ Cushing Syndrome- Sx

A
  • Buffalo hump
  • Supraclavicular fat pad enlargement
  • HTN
  • Central obesity
  • Moon face
  • Thin extremities
  • muscle weakness
  • Purple striae- thin skin
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11
Q

Hypercortisolism/ Cushing Syndrome- Dx

A
  • Dexamethasone supression test- given at 11 pm, cortisol tested at 8 am. Increase levels indicate cushing
  • Late night salivary assay
  • 24 hr urine cortisol (production)
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12
Q

Hypercortisolism/ Cushing Syndrome- Tx

A
  • Resection of pituitary or adrenal adenoma
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13
Q

Primary hyperaldosteronism- Eti

A
  • Cause of resistant HTN
  • 30-60 yrs
  • CV events
  • Due to adrenal hyperplasia
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14
Q

Primary hyperaldosteronism- Sx

A
  • Resistant hypertension (20%)

- Hypokalemia (musc weakness, paresthesias, tetany)

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15
Q

Primary hyperaldosteronism- Dx

A
  • Aldosterone to renin ratio > 67
  • Hypokalemia
  • Tx resistant HTN, severe HTN, early onset HTN
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16
Q

Primary hyperaldosteronism- Tx

A
  • Spironolactone

- Adrenalectomy

17
Q

Pheochromocytoma- Eti

A
  • Tumor of adrenal medulla

- Secrete epi/ norepi

18
Q

Pheochromocytoma- Sx

A
  • Lethal
  • Hypertensive crisis & cardiac arrhythmia
  • multi system crisis- proteinuria, nephrotic syndrome, heart, kidney & liver failure
  • Paroxysms- HTN, HA, perspiration, anxiety
19
Q

Pheochromocytoma- Dx

A
  • Metanephrines- fractioned free in plasma
  • Urinary metanephrine & creatinine
  • CT or MRI abdomen
20
Q

Pheochromocytoma- Tx

A 
- Surgical removal 
Manage BP:
- Alpha blockers
- CCBs
- Beta- blockers
21
Q

Hirsutism & Virilization- Eti

A
  • 5-10% non-asian women
  • Genetic
  • Polycystic ovary, neoplasm, ACTH cushing
  • Virilization: increased muscularity, alopecia, clitoromegaly
22
Q

Hirsutism & Virilization- Sx

A
  • Chin, lip, abd & lip hair
  • Acne
  • Menstrual irregularities
  • defeminization
  • Virilization- androgen producing neoplasm
23
Q

Hirsutism & Virilization- Dx

A
  • Serum testosterone

- Determine root cause (cushing, neoplasm, polycystic)

24
Q

Hirsutism & Virilization- Tx

A
  • Spironolactone
  • Finasteride
  • Oral contraceptives

HRR 1 (12 decks)

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