Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Med- Endo > Adrenal + Parathyroid Dz Lecture > Flashcards

Adrenal + Parathyroid Dz Lecture Flashcards

1
Q

Secretion localized to outer layer of adrenal cortex

regulated by renin secretion by kidneys

A

Aldosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Major glucocorticoid secreted by middle/inner adrenal cortex

secretion regulated by ACTH (from pituitary)

A

Cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Androgens > estrogens

testosterone, androstenedione, DHEA, estradiol

..secreted from which layer of adrenal cortex?

A

sex hormones are secreted from inner adrenal cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Inhibits insulin secretion
Increases hepatic gluconeogenesis
Decreases protein stores
Dampens defense mechanisms
Inhibits production or action of inflammation
Lowers serum calcium

A

Cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Secreted in response to:

Stress
Trauma
Infection

A

Cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Plays a major role in supporting normal circulatory function and hemodynamic stability in respons to stress

Normal daily secretion= 15-25 mgs

weak mineralcorticoid effect

A

Cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Results from excessive systemic corticosteroids

A

Cushings syndrome/disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Can be caused by….

  1. endogenous over production (ie tumor secreting cortisol or ACTH)
  2. exogenous glucocorticoid administration (steroid drugs for other condition)
A

Cushings syndrome/disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

MC cause of Cushings?

A

Pts treated with high dose corticosteroids for some other condition (ie lupus, asthma, etc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Causes:

  • Adrenal tumor (adenoma or carcinoma) which secretes excess cortisol
  • Neoplasms secreting ectopic ACTH (ie small cell lung cancer)
  • Unknown ectopic ACTH production
A

Cushings syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pituitary adenoma secreting excessive ACTH

A

Cushings disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Central obesity:

moon facies
abdominal protuberance
buffalo hump
supraclavicular fat

A

Cushings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Catabolic effects:

Thin skin with easy bruising
Striae
Thin extremities
Muscle wasting
Acne
Hirsutism
Impaired healing

A

Cushings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Glucose intolerance/DM, HTN:

Oligomenorrhea
Amenorrhea
Impotence
Weakness
HAs
Increased thirst
Polyuria
(high glucose levels)

A

Cushings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Osteopenia and osteoporosis:

Decreased bone protein

A

Cushings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Too much cortisol?

Too little cortisol?

A

Too much= Cushings

Too little= Addisons disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Labs: hyperglycemia, glycosuria, leukocytosis

*elevated cortisol levels with loss of diurnal pattern

A

Cushings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Diagnostic testing that can be done in Cushings?

A

Dexamethasone suppression test

(Dexamethasone is a steroid that mimics cortisol..should exert negative feedback on ACTH production)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Increased morbidity of…

Diabetes
HTN
Osteoporosis
Infections
Compression/pathologic fractures

A

Complications of untreated Cushings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Transphenoidal resection of the pituitary cures what percentage of Cushings?

A

75-90%

post op Rx Cortisol often needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

CORTISOL excess= ?

ACTH excess= ?

A

CORTISOL excess= Cushings syndrome

ACTH excess= Cushings disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

“stones, bones, groans, moans” is referring to having too much….

A

Calcium! (which can occur with hyperparathyroidism)

stones= renal loss of Ca and PO4, causing kidney **stones**
bones= bone loss, so **bone** pain
**groans**= increased GI absorption and abominal cramps
**moans**= irritability, psychosis, depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Obesity is centripetal
Extremities appear wasted

Fat deposition…buffalo hump, moon facies, supraclavicular pads

A

Cushings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

MOST SPECIFIC SIGNS=

proximal muscle weakness
pigmented striae over 1 cm wide

A

Cushings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

May present with HA, backache
Oligomenorrhea, amenorrhea

Disorders of calcium metabolism may cause:
Osteoporosis, vertebral fractures
Hypercalciuria, kidney stones
Possible avascular necrosis

A

Cushings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Impaired wound healing
Acne
Easy bruising
Superficial infections

A

Cushings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Prolonged administration of synthetic, exogenous glucocorticoids in supraphysiologic doses (2-40x normal)

this leads to chronic ACTH suppression

A

MC cause of Cushings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Prednisone is ___ x’s cortisol potency

A

4x!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Developing exogenous Cushings is dependent on…

A

Dose
Duration
Timing

of administration

30
Q

Chronic suppression of adrenal gland is important if/when glucocorticoids are discontinued

..why?

A

MUST taper!

31
Q

Risk factors:

Taking exogenous corticosteroids with suppression of hypothalamic pituitary adrenal axis

Can occur if corticosteroids are tapered/stopped too quickly

A

Adrenal insufficiency

32
Q

Autoimmune adrenal insufficiency

A

Addisons disease

33
Q

Autoimmune destruction of adrenal cortex that can develop over time, resulting in chronic cortisol, aldosterone and adrenal androgen deficiency

A

Addisons disease

34
Q

Decreased cortisol

Decreased aldosterone

Decreased adrenal androgens

A

Addisons disease

35
Q

S/S:

Weakness, fatigue, weight loss, myalgias, arthralgias
N/V/D, abdominal pain, anxiety, irritability

low BP, orthostasis, hyperpigmented skin (including knuckles, palmar creases, elbows, knees, nipples, nail beds, decreased axillary and pubic hair)

A

Addisons disease

36
Q

Labs: Neutropenia, lymphocytosis, eosinophilia, low AM cortisol levels, hypoNa

Abdominal CT may show small non-calcified adrenals

A

Addisons disease

37
Q

Cosyntropic (synthetic ACTH) stimulation test

..used to measure _____ ______

A

adrenal reserve

(diagnostic in adrenal insufficiency)

38
Q

Cosyntropin 250 given
Serum cortsiol obtained 30-60 mins later

..what happens in a normal/healthy individual?

A

Cortisol rises at least 20

39
Q

If pt is on hydrocortisone, how long do they need to hold the medication for before a Cosyntropin test?

A

8 hours

40
Q

Tx=

Hydrocortisone
15-20 mg in AM
5-10 mg in PM

A

Adrenal insufficiency

41
Q

During what times do you need to increase maintence dose of hydocortisone in adrenal insufficiency patients?

A

During times of stress!

..to avoid acute adrenal insufficiency/crises

(Infection, trauma, surgery, MI)

42
Q

Must TAPER steroid dose before they are D/Cd to allow what to recover?

A

Adrenal pituitary axis

(can take weeks or longer)

43
Q

What must you consider if a pt has hypotension/shock unresponsive to IV fluids and pressors

A

Acute adrenal insufficiency

(this is a medical emergency!)

44
Q

Tx=

Rapid isotonic fluids
IV hydrocortisone
Tx underlying stress
Oral hydrocortisone when stable

A

Tx for acute adrenal insufficiency

45
Q

Rare cause of secodary HTN
Tumor of adrenal medulla

increases amounts of epinepherine and norepinepherine into circulation

A

Pheochromocytoma

46
Q

HTN with HA, sweating, palpitations

Dx: 24 hr urine for catecholamines and metanephrines

Tx: removal of tumor. post-op alpha and beta blockers

A

Pheochromocytoma

47
Q

Maintains Ca homeostasis
increases osteoclastic activity in bone, resulting in delivery of Ca and PO4 into circulation
increases renal tubular reabsorption of Ca
increases PO4 excretion in urine
increases absorption of Ca from GI tract (thru synthesis of 1,25 dihydroxycholecalciferol, a vitamin D metabolite)

A

PTH

48
Q

osteoclastic activity maintains..

A

Ca levels

49
Q

___% total body Ca in solution:

50% ionized
40% protein bound
10% complexed with anions

A

1%

50
Q

Hallmark is low ionized Ca

MC post thyroidectomy

may develop with chronic Mg deficiency

A

HYPOparathyroidism

51
Q

Acute s/s:

Muscle cramps, irritable, carpopedal spasm, tetany, seizures, parasthesias of hands and feet

A

HYPOparathyroidism

52
Q

Chronic s/s:

lethargy, personality changes, decreased cognitive fxn, cataracts

A

HYPOparathyroidism

53
Q

Chvosteks and Trousseau’s sign

dry, thin nails
hyperactive reflexes

A

HYPOparathyroidism

54
Q

Labs:

decreased serum total and ionized calcium

increased PO4

low urine Ca

decreased PTH levels

A

HYPOparathyroidism

55
Q

Important to also check what levels in hypoparathyroidism?

A

Magnesium

56
Q

ECG: prolonged QT interval and arrhytmias

A

Hypoparathyroidism

57
Q

Acute tx: IV calcium gluconate

Chronic: oral calcium, calcitrol, Mg supplment

A

Hypoparathyroidism

58
Q

Hypersecretion of PTH, usually a parathyroid adenoma

Hallmark= elevated serum total and ionized calcium

A

HYPERparathyroidism

59
Q

Increased excretion of Ca and PO4 by kidney, which overwhelms tubular Ca absorptive capacity

..leading to?

A

HYPERcalciuria

60
Q

Chronic hyperparathyroidism can do what to bones?

A

increases bone resorption (process by which osteoclasts break down bone)

61
Q

Process by which osteoclasts break down bone
Seen in chronic hyperparathyroidism

A

Bone resorption

62
Q

Diffuse demineralization
Osteopenia
Osteoporosis
Pathologic fractures

A

seen in HYPERparathyroidism (if there is severe bone resorption)

63
Q

Often asymptomatic, found incidentally

Can cause…bone pain, arthralgias

hypercalcemia/hypercalciuria can result in nephrogenic diabetes insipidus (decreased sensitivity to ADH) with polyuria and polydipsea

A

Hyperparathyroidism

64
Q

Hypercalcemia/hypercalciuria can result in…

A

diabetes insipidus (decreased sensitivity to ADH)

65
Q

Anorexia
Lethargy
Fatigue
Weakness
Pancreatitis
Altered MS
Nausea
Constipation
Increased BP

A

Can result with very high calcium levels

66
Q

elevated serum Ca (over 10.5)
elevated ionized Ca
decreased PO4
elevated Ca in 24hr urine
elevated alk-phos (bone dz)
PTH assay via RIA

A

Labs of hyperparathyroidism

67
Q

Pathologic fractures
Urinary stones, obstruction, UTIs
Renal failure
CNS changes
PUD
Pancreatitis

A

Complications of hyperparathyroidism

68
Q

What must you rule out if you get a high Ca level?

A

Malignancy!

(also..if you get 1 high Ca, must repeat)

69
Q

Bisphosphonates (inhibit bone resorption)

Parathyroidectomy

A

Tx for hyperparathyroidism

70
Q

SYMPTOMATIC with bone disease or kidney stone

ASYMPTOMATIC with:
significant hypercalciuria
cortical bone density greater than 2 SDs below norm
age under 50
Ca over 1.0 above upper limit norm
pregnant (2nd trimester)

A

Indications for parathyroidectomy

71
Q

Elevated calcium with low PTH indicates a secondary disorder, such as…

A

Malignancy

Clin Med- Endo (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions