Adrenal N Pancreas Flashcards
Metabolic syndrome- 3 criteria must b met out of the ff 5
- Abdominal obesity ( M>40, F>35 inches);
- impaired fasting glycemia
- BP>130/80
- TGA>150
- HDL(<40M, <50F)
What plays the central role in metabolic syndrome?
Insulin resistance
Secretory, high volume, watery, low osmotic gap diarrhea; hypercalcemia; hyperglycemia; hypokalemia; achlorohydria; pancreatic mass mostly in the tail
Dx?
VIPoma
Cushing syndrome is an important cause of secondary htn; hyperglycemia, hypokalemia
How?
ACTH dependent hormones like deoxycorticosterone, corticosterone n cortisol lead to vasoconstriction, insulin resistance n mineralocorticoid activity
Dapagliflozin, canagliflozin, group, MOA, side effects
SGLT2 inhibitors
Inhibit reabsorption of glucose in the PCT. Increased risk of UTI, fungal vaginitis
- has cardiovascular benefits, weight n BP reduction
Ectopic ACTH causes more severe htn n hypokalemia. Why?
Cortisol has high affinity for mineralocorticoid receptors but is normally converted to inactive cortisone by the enzyme 11-beta hydroxyl dehydrogenase in the renal tubular cells. High cortisol from ectopic ACTH can saturate the enzyme…
The most accurate measure of severity in DKA?
Serum bicarbonate level or anion gap
MOA of metformin, weight
Blocks gluconeogenesis, no wt gain
Incretins are?
GIP n GLP r secreted when food esp CHOs enter the duodenum and they increase insulin release, decrease glucagon release
S/E - wt gain, edema, CHF, bone #
Bladder Ca …. r for which hypoglycemic drugs?
Thiazolindinediones/glitazones
Nateglinide, repaglinide
Group, MOA
Meglitinides
- similar to sulfonylureas but no sulfa and r short acting
Gastroparesis
- sxs
- Rx
Bloating, constipation, early satiety, vomiting
-Rx - metoclopramide or erythromycin
Pramilinitide
Amylin analog
Amylin is normally secreted with insulin n decreases gastric emptying, glucagon level n appetite
MEN1, 2A, 2B
MEN1- pituitary, PTH, pancreases
MEN2A- PTH, medullary thyroid, pheochromocytoma
MEN2B- mucosal neuroma, medullary, pheochromo
The best initial therapy in pheochromo
Phenoxybenzamine
Hyperglycemia, non-specific sxs like diarrhea, anemia, wt loss and necrotic migratory erythema
Glucagonoma
Episodic headache, htn, palpitation, tremor, sweating
Pheochromocytoma
Addison disease is most commonly (>80%) caused by
Autoimmune destruction of the gland. Pts May have involvement of other glands such as thyroid, Parath, ovaries and other autoimmune phenomenon like vitiligo.
Exenatide, liraglutide…
group, MOA, weight
Incretin mimetic
Direct replacement of incretins
Decrease wt
Sitagliptin, saxagliptin
Group, MOA, wt
DPP-lV inhibitors
Inhibit metabolism of incretins by DPP-lV
Are wt neutral
Cosyntropin stimulation test is?
Initial evaluation of hypocortisolism is?
The most specific test for adrenal function
Cosyntropin is a synthetic ACTH. Normally, there should b a rise in cortisol after cosyntropin administration
- initially- 8AM serum cortisol and ACTH
cosyntropin test is concurrently performed since ACTH assay takes several days.
Primary hyperaldosteronism best initial test
Ratio of plasma aldosterone to renin is diagnostic
Based on HbA1c goal of therapy?cut off for Dx, normal
Goal<7%
Dx - >6.5
Normal<5.7
Once u confirm an elevated ACTH level in a suspected Cushing syndrome, u can scan the brain. What’s the next step iF the MRI doesn’t show a clear pituitary lesion?
Do inferior petrosal venous sinus sampling for ACTH ( the venous drainage of the pituitary)
If negative, look for ectopic ACTH production by scanning the chest
