Adrenal + Parathyroid Flashcards
what 2 hormones do the adrenal glands release?
aldosterone
cortisol
what hormone does cortisol inhibit?
insulin
does cortisol increase or decrease sugar levels?
increase
what are the 2 main causes of cushing’s syndrome?
*1. steroid drug use
- tumors secreting cortisol or ACTH (MC adrenal)
what are some s/s of cushing’s syndrome?
central obesity (moon face, buffalo hump)
catabolic effects (wasting, thin skin)
diabetes
hypertension
osteopenia/porosis
what lab test diagnoses cushing’s syndrome?
dexamethasone suppression test
what should normally happen when you administer dexamethasone?
suppresses ACTH/cortisol
what should you think if you administer dexamethasone and there is no response?
tumor secreting ACTH/cortisol
for cushings syndrome, what do you measure in a 24h urine?
free cortisol : creatinine
how do you treat cushings disease (if not caused by steroids)
resect tumor
postop cortisol
why do we taper steroids
may cause chronic suppression of adrenal glands when quickly d/c
what should you suspect in anyone with fatigue, weakness, or HoTN w/ really nonspecific sx?
adrenal insufficiency
what is an autoimmune cause of adrenal insufficiency?
addison’s disease
when do you check cortisol levels for someone with adrenal insufficiency?
in the morning
what will you see on CT scan of someone with addisons?
non-calcified, small adrenals
how do you diagnose adrenal insufficiency?
cosyntropin (synthetic ACTH) stimulation test
how do you treat adrenal insufficiency?
gluco/mineralcorticoid replacement
diurnal pattern
by how much must you increase glucocorticoid replacement therapy during times of stress?
8-10x
what should you suspect in someone with suppressed adrenals + a stress event that has HoTN that doesn’t respond?
acute adrenal insufficiency
how do you tx acute adrenal insufficiency?
IV hydrocortisone
rapid isotonic fluids
why are you so rapidly giving fluids for acute adrenal insufficiency?
it’s a life-threatening emergency
what rare cause of 2ndary HTN is caused by a tumor of the adrenal medulla that increases NE and epi?
pheochromocytoma
how might a pt present with pheochromocytoma
sustained HTN
bad HA
sweating
palpitations
how do you diagnose pheochromocytoma?
24h urine for catecholamines + metanephrines
how do you tx pheochromocytoma?
surgery
+ alpha blockers + beta blockers
what does PTH do?
calcium homeostasis
osteoclastic activity
if a person has hypoparathyroidism, will Ca be high or low
low
what deficiency may hypoparathyroidism lead to?
Mg
what are some of the more unique s/s or hypoparathyroidism?
carpopedal spasm
seizures
paresthesias
personality changes
Chvostek’s sign + Trosseau’s sign
dry, thin nails, hyperactive reflexes
in hypoparathyroidism will PO4 be high or low
high
in hyperparathyroidism is Ca high or low
high
hyperparathyroidism is usually an incidental finding, but what might clue you into the dx?
” psychic moans, abdominal groans, kidney stones, painful bones”
how do you treat hyperparathyroidism?
NS + furosemide
what are the qualifications for surgery on hyperparathyroidism?
if sx: must have bone disease or stones
if asx: must have low bone density, be in 2nd trimester, or not have calcuria
