Adrenal, pituitary gland, DM, HLD Flashcards
What are the 3 zones of the adrenal gland and what does each zone produce
Zona Glomerulosa- Aldosterone
Zona Fasciculata- Cortisol
Zona Reticularis- Estrogens/Androgens
GFR- ACE
MCC of addison’s disease in industrialized countries
Autoimmune- causes adrenal atrophy
MCC of addison’s disease worldwide
Infection (TB*, HIV)
Lack of cortisol AND aldosterone
primary adrenocortical insufficiency
(Addison’s)
Lack of cortisol ONLY (aldosterone intact b/c of RAAS)
Secondary adrenocortical insufficiency
due to pituitary failure of ACTH secretion
What is the MCC of secondary adrenocortical insufficiency and OVERALL insufficiency
exogenous steroid use
S/s of what:
- Hyperpigmentation
- decr. aldosterone: Orthostatic hypotension, hyponatremia, hyperkalemia, metabolic acidocis
- decr. sex hormones in women
Addisons
what will be seen on CMP in a patient with Addisons
Hyponatremia
HYPEKALEMIA
non anion gap metabolic acidosis
hypoglycemia
(aldosterone normally causes Na retention in exchange for K and H, so in Addisons this will happen in reverse)
how do you dx adrenocortical insufficiency
tx for Adrenocortical Insufficiency
Addisons: Glucocorticoids (Hydrocortisone) + Mineralcorticoids (Fludrocortisone)
2ry: Glucocorticoids only (Hydrocortisone)
MCC Cushing’s Syndrome
Long term high dose corticosteroid therapy
What are 3 endogenous causes of Cushing’s Syndrome (hypercortisolism)
Benign Pituitary Adenoma
ACTH secreting small cell lung tumor
Adrenal tumor (cortisol-secreting)
What should be seen on a low-dose dexamethasone suppression test in Cushings disease
suppression (of ACTH)
(Dexamethasone is 4x more potent than cortisol)
tx for pheochromocytoma
complete adrenalectomy
pre-op: nonselective α-blockade: phenoxybenzamine or phentolamine x 7-14 days followed by BBs to control HTN.
tx for prolactinoma
Dopamine agonist (dopamine inhibits prolactin): Cabergoline or Bromocrpitine
Tx for Acromegaly
TSS + Bromocriptine
Octreotide
What does a somatotropinoma cause
Adults–> Acromegaly
Kids–> Gigantism
+ DM and glucose intolerance (GH incr. glucose)
What test do you use to dx acromegaly
What are 4 complications of acromegaly/gigantism
- Diabetes
- Congestive Heart Failure
- GI cancers
- Carpal Tunnel
How do you screen for Acromegaly
Increased Insulin-like growth factor
If you find insulin-like growth factor to be elevated, how do you CONFIRM acromegaly/gigantism?
Oral glucose suppression test (give glucose)
Incr. GH= Acromegaly
What are the pre-prandial and post-prandial blood sugar goals in a patient with DM
Pre-prandial: 80-130
Post-prandial: <180
MCC nephrogenic DI
(3 common causes)
MCC- lithium
amphotericin B
Demeclocycline
Polyuria + polydipsia
nocturia
Hypernatremia (if decr. H20 intake)
Diabetes insipidus
(central= not making ADH,
Nephrogenic= kidney not responding to ADH)
Tx for Central DI
Desmopressin (synthetic ADH)
Carbamazepine
Tx for nephrogenic DI
Na/protein restriction
Hydrochlorothiazide
Indomethacin
sxs= hypotonic fluid
What are the two primary manifestations of Growth hormone deficiency (dwarfism) in infancy
hypoglycemia and micropenis
What is seen on labs in dwarfism
↓ GH, ↓ IGF1
What is an important diagnostic test to order when evaluating a patient you believe to have dwarfism
x-ray of hand (to show bone age vs. chronological age
bone age usu. >2yrs behind chronological age
What are 3 possible causes of hypercholesterolemia
Hypothyroidism
Pregnancy
Kidney failure
What are 5 possible causes of hypertryiglyceridemia
DM
ETOH
obesity
Steroids
Estrogen
When do you start screening for hyperlipidemia in those at higher risk? (HTN, smoking, FHx)
males: 20-25y/o
females: 30-35y/o
When do you start screening for hyperlipidemia in those at LOWER risk?
males: 35y/o
females: 45y/o
What risk calculator do you use to determine if someone should be started on a statin
ASCVD risk calculator
When should someone be started on a statin
- DM 40-75y/o w/ LDL 70-189
- 40-75y/o WITHOUT CVD + >7.5% 10yr risk
- >21y/o w/ LDL >190
- Atherosclerotic cardiovascular dz
What medication is best at increasing HDL
Niacin (may cause hyperglycemia)
At what LDL level should someone over 21y/o be started on a statin
>190
What is the only lipid lowering agent safe to use in pregnancy
Bile acid sequestrants
What condition are xanthomas (esp. xanthelasma) seen in ?
hypercholesterolemia
What are the 2 high intensity statins
Atorvastatin 40-80mg
Rosuvastatin 20mg
What are considered moderate intensity statins
Atorvastatin 10mg
Simvastatin 20-40mg
