Ch. 575 - Adrenocortical Insufficiency

Question 1

Acquired primary adrenal insufficiency

Answer 1

Addison disease

Question 2

Adrenal insufficiency: Deficiency of ACTH

Answer 2

Secondary adrenal insufficiency

Question 3

MCC of adrenocortical insufficiency

Answer 3

Salt-losing forms of CAH

Question 4

Conditions that manifest as salt-losing symptoms in newborn period because they are unable to synthesize either cortisol or aldosterone

Answer 4

21-hydroxylase deficiency, lipoid adrenal hyperplasia, 3β -hydroxysteroid dehydrogenase deficiency

Question 5

Adrenocortical deficiency associated with demyelination in the CNS

Answer 5

ALD

Question 6

T/F MC form of ALD is X-linked

Answer 6

T

Question 7

Chronic adrenal insufficiency, isolated deficiency of glucocorticoids, elevated ACTH, generally normal aldosterone

Answer 7

Familial glucocorticoid deficiency

Question 8

MCC of Addison disease

Answer 8

Autoimmune destruction of adrenal glands

Question 9

MC infectious etiology for adrenal insufficiency

Answer 9

Meningococcemia

Question 10

Adrenal crisis from meningococcemia

Answer 10

Waterhouse-Friderichsen syndrome

Question 11

Most definitive test for primary adrenal insufficiency

Answer 11

Measurement of serum levels of cortisol before and after administration of ACTH

Question 12

When congenital adrenal hyperplasia is suspected, ___ should be measured along with cortisol in the ACTH stimulation test

Answer 12

Cortisol precursors

Question 13

Management of acute adrenal insufficiency

Answer 13

IV solution of D5NSS (correct hypogly, hyponat, and hypovolemia), IV hydrocortisone

Question 14

Used to monitor adequacy of glucocorticoid replacement in primary adrenal insufficiency

Answer 14

ACTH levels

Question 15

During periods of stress, dose of hydrocortisone for patients with primary adrenal insuff should be increased by

Answer 15

2-3x

Question 16

Synthetic mineralocorticoid given orally for patients with aldosterone deficiency

Answer 16

Fludrocortisone

Question 17

High-dose glucocorticoids is defined as

Answer 17

> 10x physiologic

Question 18

High-dose glucocorticoids can be administered for how long without requiring a subsequent taper of dose

Answer 18

1 week

Question 19

MCC of corticotropin deficiency

Answer 19

Destructive lesions in the area of the pituitary e.g. craniophayrngioma and germinoma

Question 20

Up to 60% of children with ___ have secondary adrenal insufficiency

Answer 20

Prader-Willi syndrome

Question 21

Gold standard to test for secondary adrenal insufficiency

Answer 21

Insulin-induced hypogly BUT too dangerous; second gold std uses metyrapone

Question 22

MC used test to diagnose secondary adrenal insufficency

Answer 22

Low-dose ACTH stimulation testing

Question 23

Physiologic dose of hydrocortisone

Answer 23

10mg/BSA/24h