CABS- Endocrine HTN

Question 1

3 main adrenal gland causes of HTN

Answer 1

pheochromocytoma
primary aldosteronism (Conn’s)
cushing syndrome

Question 2

thyroid causes of HTN

Answer 2

hyperthyroidism

Question 3

pituitary causes of HTN

Answer 3

acromegaly
cushing disease

Question 4

tumor that arises from Chromaffin cells of adrenal medulla

Answer 4

pheochromocytoma

Question 5

pt presents with HA, sweating, palpitations, HTN, anxiety, feeling of impending death

Answer 5

pheochromocytoma

Question 6

first 2 steps to diagnose pheochromocytoma

Answer 6

urine metanephrine
plasma metanephrine

Question 7

MRI w/ I-MIBG +/or Ga-DOTATE scan to diagnose what (adrenal or extradrenal)

Answer 7

pheochromocytoma

Question 8

first line to treat pheochromocytoma (alpha blocker)

Answer 8

phenoxybenzamine

Question 9

2nd line to treat pheochromocytoma

Answer 9

metoprolol

Question 10

how to definitively treat pheochromocytoma

Answer 10

surgery

Question 11

end product of epi and NE

Answer 11

VMA

Question 12

epi into _____ by MAO enzyme

Answer 12

metanephrine

Question 13

NE into ___ by MAO enzyme

Answer 13

normetanephrine

Question 14

why epinephrine-secreting pheochromocytomas are almost exclusively localized to adrenal medulla?

Answer 14

b/c adrenal medulla is only tissue to normally produce large amounts of epi due to presence of PNMT

Question 15

crucial enzyme for turning norepinephrine into epinephrine

Answer 15

PNMT

Question 16

not used as initial antihypertensive agent in pheochromocytoma b/c it can cause intraoperative HTN

Answer 16

Labetolol

Question 17

more of a beta blocker than alpha blocker

Answer 17

Labetolol

Question 18

____ can increase blood glucose by inhibiting insulin secretion via alpha2 agonism in beta cells

Answer 18

catecholamines

Question 19

too much cortisol in Cushing saturates ______ which then allows it to bind and create apparent mineralocorticoid excess (causing hypokalemia and hypernatremia)

Answer 19

11beta-HSD2

Question 20

normal plasma ____ at 8AM is 5-23 microgram/mL

Answer 20

cortisol

Question 21

increase in ACTH and cortisol and responds to dexamethasone

Answer 21

Cushing Disease (ACTH-producing pituitary adenoma)

Question 22

increase in CRH, ACTH, and cortisol

Answer 22

pseudo-Cushing (depression/anxiety)

Question 23

increase in cortisol and decrease in ACTH; has little effect from dexamethasone

Answer 23

adrenal tumor

Question 24

increase in ACTH and cortisol; doesn’t respond to dexamethasone

Answer 24

ectopic ACTH/CRH

Question 25

urine free cortisol>3x above normal

Answer 25

cushing

Question 26

midnight plasma cortisol>7.5

Answer 26

cushing

Question 27

overnight high dose dexamethasone; cortisol at 8 AM >1.8

Answer 27

cushing syndrome

Question 28

synthetic steroid that reduces cortisol levels by binding to same receptor as cortisol and decreases amount of ACTH released by pituitary gland

Answer 28

dexamethasone

Question 29

______ works at high doses to suppress ACTH producing pituitary adenoma

Answer 29

dexamethasone

Question 30

stress will ______ secretion of CRH from cell to stimulate ACTH and then cortisol

Answer 30

increase

Question 31

normal or increased ACTH when measured (what differentials)

Answer 31

Cushing disease (ACTH-producing pituitary adenoma)
pseudo-Cushing
ectopic ACTH/CRH

Question 32

decreased ACTH when measured (what differentials)

Answer 32

adrenal tumor
iatrogenic cushing

Question 33

CRH and high dose DST +

Answer 33

Cushing Disease

Question 34

CRH and high dose DST -

Answer 34

Ectopic ACTH/CRH

Question 35

HTN + hypokalemia + metabolic alkalosis

Answer 35

Primary Aldosteronism (Conn’s)

Question 36

to measure and diagnose Conn’s

Answer 36

increased PAC (aldosterone)
decreased PRA (renin)

Question 37

to measure and diagnose secondary hyperaldosteronism

Answer 37

elevated PAC and PRA

Question 38

confirmatory test for primary aldosteronism (Conn’s)

Answer 38

oral salt loading (NaCl); increased NaCl, decreased renin, increased aldosterone

Question 39

24 hour urinary aldosterone excretion >12micrograms

Answer 39

Conn’s

Question 40

vitamin deficiency in pt with pheochromocytoma

Answer 40

vitamin C (dopamine into NE; tryptophan into serotonin)

Question 41

in MEN I, the most common secretory product of pancreatic and duodenal endocrine lesions

Answer 41

gastrin

Question 42

blocks alpha1 in VSMC
blocks beta1 in juxtaglomerular cells (inhibits renin)
blocks beta1 in SA node

Answer 42

Labetolol