Adrenal + Parathyroid

Question 1

what 2 hormones do the adrenal glands release?

Answer 1

aldosterone

cortisol

Question 2

what hormone does cortisol inhibit?

Answer 2

insulin

Question 3

does cortisol increase or decrease sugar levels?

Answer 3

increase

Question 4

what are the 2 main causes of cushing’s syndrome?

Answer 4

*1. steroid drug use

2. tumors secreting cortisol or ACTH (MC adrenal)

Question 5

what are some s/s of cushing’s syndrome?

Answer 5

central obesity (moon face, buffalo hump)

catabolic effects (wasting, thin skin)

diabetes

hypertension

osteopenia/porosis

Question 6

what lab test diagnoses cushing’s syndrome?

Answer 6

dexamethasone suppression test

Question 7

what should normally happen when you administer dexamethasone?

Answer 7

suppresses ACTH/cortisol

Question 8

what should you think if you administer dexamethasone and there is no response?

Answer 8

tumor secreting ACTH/cortisol

Question 9

for cushings syndrome, what do you measure in a 24h urine?

Answer 9

free cortisol : creatinine

Question 10

how do you treat cushings disease (if not caused by steroids)

Answer 10

resect tumor

postop cortisol

Question 11

why do we taper steroids

Answer 11

may cause chronic suppression of adrenal glands when quickly d/c

Question 12

what should you suspect in anyone with fatigue, weakness, or HoTN w/ really nonspecific sx?

Answer 12

adrenal insufficiency

Question 13

what is an autoimmune cause of adrenal insufficiency?

Answer 13

addison’s disease

Question 14

when do you check cortisol levels for someone with adrenal insufficiency?

Answer 14

in the morning

Question 15

what will you see on CT scan of someone with addisons?

Answer 15

non-calcified, small adrenals

Question 16

how do you diagnose adrenal insufficiency?

Answer 16

cosyntropin (synthetic ACTH) stimulation test

Question 17

how do you treat adrenal insufficiency?

Answer 17

gluco/mineralcorticoid replacement

diurnal pattern

Question 18

by how much must you increase glucocorticoid replacement therapy during times of stress?

Answer 18

8-10x

Question 19

what should you suspect in someone with suppressed adrenals + a stress event that has HoTN that doesn’t respond?

Answer 19

acute adrenal insufficiency

Question 20

how do you tx acute adrenal insufficiency?

Answer 20

IV hydrocortisone

rapid isotonic fluids

Question 21

why are you so rapidly giving fluids for acute adrenal insufficiency?

Answer 21

it’s a life-threatening emergency

Question 22

what rare cause of 2ndary HTN is caused by a tumor of the adrenal medulla that increases NE and epi?

Answer 22

pheochromocytoma

Question 23

how might a pt present with pheochromocytoma

Answer 23

sustained HTN

bad HA

sweating

palpitations

Question 24

how do you diagnose pheochromocytoma?

Answer 24

24h urine for catecholamines + metanephrines

Question 25

how do you tx pheochromocytoma?

Answer 25

surgery + alpha blockers + beta blockers

Question 26

what does PTH do?

Answer 26

calcium homeostasis osteoclastic activity

Question 27

if a person has hypoparathyroidism, will Ca be high or low

Answer 27

low

Question 28

what deficiency may hypoparathyroidism lead to?

Answer 28

Mg

Question 29

what are some of the more unique s/s or hypoparathyroidism?

Answer 29

carpopedal spasm seizures paresthesias personality changes Chvostek's sign + Trosseau's sign dry, thin nails, hyperactive reflexes

Question 30

in hypoparathyroidism will PO4 be high or low

Answer 30

high

Question 31

in hyperparathyroidism is Ca high or low

Answer 31

high

Question 32

hyperparathyroidism is usually an incidental finding, but what might clue you into the dx?

Answer 32

" psychic moans, abdominal groans, kidney stones, painful bones"

Question 33

how do you treat hyperparathyroidism?

Answer 33

NS + furosemide

Question 34

what are the qualifications for surgery on hyperparathyroidism?

Answer 34

if sx: must have bone disease or stones if asx: must have low bone density, be in 2nd trimester, or not have calcuria