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MJ- Elective 1 EOR > Adrenal, pituitary gland, DM, HLD > Flashcards

Adrenal, pituitary gland, DM, HLD Flashcards

1
Q

What are the 3 zones of the adrenal gland and what does each zone produce

A

Zona Glomerulosa- Aldosterone

Zona Fasciculata- Cortisol

Zona Reticularis- Estrogens/Androgens

GFR- ACE

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2
Q

MCC of addison’s disease in industrialized countries

A

Autoimmune- causes adrenal atrophy

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3
Q

MCC of addison’s disease worldwide

A

Infection (TB*, HIV)

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4
Q

Lack of cortisol AND aldosterone

A

primary adrenocortical insufficiency

(Addison’s)

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5
Q

Lack of cortisol ONLY (aldosterone intact b/c of RAAS)

A

Secondary adrenocortical insufficiency

due to pituitary failure of ACTH secretion

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6
Q

What is the MCC of secondary adrenocortical insufficiency and OVERALL insufficiency

A

exogenous steroid use

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7
Q

S/s of what:

  • Hyperpigmentation
  • decr. aldosterone: Orthostatic hypotension, hyponatremia, hyperkalemia, metabolic acidocis
  • decr. sex hormones in women
A

Addisons

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8
Q

what will be seen on CMP in a patient with Addisons

A

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)

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9
Q

how do you dx adrenocortical insufficiency

A
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10
Q

tx for Adrenocortical Insufficiency

A

Addisons: Glucocorticoids (Hydrocortisone) + Mineralcorticoids (Fludrocortisone)

2ry: Glucocorticoids only (Hydrocortisone)

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11
Q

MCC Cushing’s Syndrome

A

Long term high dose corticosteroid therapy

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12
Q

What are 3 endogenous causes of Cushing’s Syndrome (hypercortisolism)

A

Benign Pituitary Adenoma

ACTH secreting small cell lung tumor

Adrenal tumor (cortisol-secreting)

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13
Q

What should be seen on a low-dose dexamethasone suppression test in Cushings disease

A

suppression (of ACTH)

(Dexamethasone is 4x more potent than cortisol)

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14
Q

tx for pheochromocytoma

A

complete adrenalectomy

pre-op: nonselective α-blockade: phenoxybenzamine or phentolamine x 7-14 days followed by BBs to control HTN.

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15
Q

tx for prolactinoma

A

Dopamine agonist (dopamine inhibits prolactin): Cabergoline or Bromocrpitine

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16
Q

Tx for Acromegaly

A

TSS + Bromocriptine

Octreotide

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17
Q

What does a somatotropinoma cause

A

Adults–> Acromegaly

Kids–> Gigantism

+ DM and glucose intolerance (GH incr. glucose)

18
Q

What test do you use to dx acromegaly

A
19
Q

What are 4 complications of acromegaly/gigantism

A
  1. Diabetes
  2. Congestive Heart Failure
  3. GI cancers
  4. Carpal Tunnel
20
Q

How do you screen for Acromegaly

A

Increased Insulin-like growth factor

21
Q

If you find insulin-like growth factor to be elevated, how do you CONFIRM acromegaly/gigantism?

A

Oral glucose suppression test (give glucose)

Incr. GH= Acromegaly

22
Q

What are the pre-prandial and post-prandial blood sugar goals in a patient with DM

A

Pre-prandial: 80-130

Post-prandial: <180

23
Q

MCC nephrogenic DI

(3 common causes)

A

MCC- lithium

amphotericin B

Demeclocycline

24
Q

Polyuria + polydipsia

nocturia

Hypernatremia (if decr. H20 intake)

A

Diabetes insipidus

(central= not making ADH,

Nephrogenic= kidney not responding to ADH)

25
Q

Tx for Central DI

A

Desmopressin (synthetic ADH)

Carbamazepine

26
Q

Tx for nephrogenic DI

A

Na/protein restriction

Hydrochlorothiazide

Indomethacin

sxs= hypotonic fluid

27
Q

What are the two primary manifestations of Growth hormone deficiency (dwarfism) in infancy

A

hypoglycemia and micropenis

28
Q

What is seen on labs in dwarfism

A

↓ GH, ↓ IGF1

29
Q

What is an important diagnostic test to order when evaluating a patient you believe to have dwarfism

A

x-ray of hand (to show bone age vs. chronological age

bone age usu. >2yrs behind chronological age

30
Q

What are 3 possible causes of hypercholesterolemia

A

Hypothyroidism

Pregnancy

Kidney failure

31
Q

What are 5 possible causes of hypertryiglyceridemia

A

DM

ETOH

obesity

Steroids

Estrogen

32
Q

When do you start screening for hyperlipidemia in those at higher risk? (HTN, smoking, FHx)

A

males: 20-25y/o
females: 30-35y/o

33
Q

When do you start screening for hyperlipidemia in those at LOWER risk?

A

males: 35y/o
females: 45y/o

34
Q

What risk calculator do you use to determine if someone should be started on a statin

A

ASCVD risk calculator

35
Q

When should someone be started on a statin

A
  • 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
36
Q

What medication is best at increasing HDL

A

Niacin (may cause hyperglycemia)

37
Q

At what LDL level should someone over 21y/o be started on a statin

A

>190

38
Q

What is the only lipid lowering agent safe to use in pregnancy

A

Bile acid sequestrants

39
Q

What condition are xanthomas (esp. xanthelasma) seen in ?

A

hypercholesterolemia

40
Q

What are the 2 high intensity statins

A

Atorvastatin 40-80mg

Rosuvastatin 20mg

41
Q

What are considered moderate intensity statins

A

Atorvastatin 10mg

Simvastatin 20-40mg

MJ- Elective 1 EOR (8 decks)

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