clinical adrenal Flashcards
2 general presentations of adrenal disorders
- hormonal
2. mass effect
3 hormonal presentations of adrenal
- overproduction
- underproduction
- mixed
4 possible overproduction syndromes
- GC - cushings
- MC - Conn’s
- Sex - virilization
- epi - pheochromocytoma
disorder of underproduction
addison’s
disorder of mixed production
CAH
3 types of mass effects
- single
- multiple
- hyperplasia
Sx of cushings
- central obesity
- moon face
- metabolic syndrome
- weakness
- osteoporosis
- stria (purple)
what is lab test for cushings
24hr cortisol test
what is used for cushings suppression test
dexamethosone
what to look for in supression test
- ACTH high - secondary (pit) or ectopic
2. ACTH low - adrenal (primary)
what are 2 main Sx of hyperaldosteronsim and why?
hypertension -Na
hypokalemia - K excretion
what hormones expected to see in hyperaldosteronism (2)
- high aldosterone
2. low renin
what is suppression test for aldosteron
salt load -
what hormone to look at to determine where problem is?
renin - high = secondary
renin - low = primary
what is most effective drug in primary hyperaldosteronism
Na channel blocker - works at level of kidney - post aldo
other medical treatment of hyperaldosterone
aldostreone receptor blocker
what is suspect in cases of severe sexual virilization
adrenal carcinoma
what to measure in severe virilization
DHEAS - adrenal specific
what is pheochromocytoma
high catecholames
what are Sx of pheo
3 Ps:pain(head), palpitations, perspiration + hypertension
what to measure to confirm pheo
epiner/norepi + metanephrine/noemeta
what is preoperative treatment of pheo
a-blocker to help with vasoconsriction, if tachycardic - add B-blocker
what is adrenal underproduction
addisons
what are Sx of addisons
low BP that DROPs on standing low Na low glucose high K hyperpigmentation
what is first thing to do in hyperadrenal
TREAT via saline and high dose steroids
what is test to assess level
ACTH
