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Endocrine > Cushing's, Addison's, SIADH, Diabetes Insipidu > Flashcards

Cushing's, Addison's, SIADH, Diabetes Insipidu Flashcards

1
Q

Causes of Cushing’s?

A

ACTH hyper secretion by the pituitary
Adrenal tumors
Chronic administration of glucocorticoids

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2
Q

Causes of Addison’s?

A

Deficient Cortisol, androgens, aldosterone***
Autoimmune destruction of adrenal gland
Metastatic cancer
Bilateral adrenal hemorrhage
Pituitary failure resulting in decreased ACTH

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3
Q

Signs and symptoms of Cushing’s

A 
central obesity
moon face with buffalo hump
poor wound healing
hrsutism
HTN
amenorrhea
impotence
headache
polyuria and thirst
labile mood
frequent infections
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4
Q

signs and symptoms of Addison’s?

A

hyper pigmentation in buccal mucosa and skin creases
Diffuse tanning and freckles
Orthostasis and hypotension
Scant axillary and pubic hair
Rapid worsening of chronic signs and symptoms

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5
Q

Labs and Diagnostics of Addison’s

A

Hypoglycemia, hyponatremia, hyperkalemia**
Elevated ESR, lymphocytosis
plasma cortisol < 5 @ 0800

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6
Q

labs and diagnostics of Cushing’s

A

hyperglycemia, hypernatremia, hypokalemia***
Glycosuria, leukocytosis
Elevated plasma cortisol in the a.m
Dexamethasone suppression test to differentiate cause
Serum ACTH

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7
Q

Management of Cushing’s

A 
Dc medication inducing symptoms
Transphenoidal resection of a pituitary adenoma
Surgical removal of adrenal tumors
Resection of ACTH secreting tumors
Manage electrolytes
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8
Q

Management of Addison’s Outpatient

A

specialist referal
glucocorticoid and mineralcorticoid replacement (hydrocortisone (glucocorticoid effect) and Fludrocortisone (florinef) (mineralocorticoid effect)

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9
Q

Management of Addison’s Inpatient

A

Hydrocortisone 110-300 IV with NS: replace volume with D5NS at 500 cc/h x 4 hours then taper per condition
Vasopressors usually ineffective
Tx underlying cause-usually infection

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10
Q

Cause/etiology of SIADH

A

Release of ADH occurs independent of osmolality or volume dependent stimulation

  • inappropriate water retention
  • tumor production of adh
  • skull fractures/head trauma
  • cns disorder
  • chronic lung dz
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11
Q

Signs and symptoms SIADH

A 
Neurologic changes***: headache, seizure, coma
neuro changes r/t hyponatremia***
Decreased DTRs
Hypothermia
weight gain/edema
Nausea, vomiting
Cold intolerance
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12
Q

Labs and Diagnostics SIADH

A

hyponatremia: yet euvolemic
decreased serum osmolality ( 100)
Urine sodium > 20
Renal, cardiac, thyroid function normal

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13
Q

Causes/etiology DI (central)

A

related to pituitary or hypothalamus damage resulting in ADH deficiency
(various causes including metastatic carcinoma to infection to trauma)

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14
Q

Causes/etiology DI (nephrogenic)

A

Due to a defect in the renal tubules resulting in renal insensitvity to ADH

  • familial x-linked trait
  • acquired due to pyelonephritis, K depletion, sickle cell anemia, chronic hypercalcemia, medications (lithium, methicillin etc)
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15
Q

S & S DI

A 
Thirst/craving fluids
polyuria and nocturia
wieght loss, fatigue
ALOC
Dizziness
Elevated temp
tachycardia
Hypotension
poor turgur and dry mucus membranes
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16
Q

Labs and diagnostics DI

A

hypernatremia
BUN/Crt elevated
serume osmo > 290
Urine Osmo < 100
urine specific gravity low < 1.005
if central Di is suspected a vasopressin challenge test- 0.05 -0.1 nasally or 1 ug SQ or IV with measurement of urine volume. Test is positive in central DI and negative in nephrogenic DI
-if no apparent cause then MRI to look for mass/lesion

17
Q

management SIADH

A

if serum Na > 120 restrict fluids to 1000 ml/24 hours and monitor
-if serum Na 110-120 w/o neuro sxs restric fluids to 500 ml/hr
if serum Na < 110 or neuro sxs replace with ISOTONIC (NS) or HYPERTONIC (3% or 5%) saline and Lasix at 1-2 mEq/hr
-monitor Na, K losses hourly and replace

18
Q

Management of DI

A

If serum Na > 150 give D5 W IV to replace 1/2 volume deficit in 12-24 hours: note: more rapid lower of Na can cause cerebral edema

  • when Na < 150 substitute 1/2 or .9% NS
  • DDAVP 1-4 ug IV or Sq q 12-24 hours for acute situations
  • maintenance dose DDAVP is 10 ug every 12-24 hours intra nasally**
19
Q

Pheochromocytoma

A

results from excess catecholamine release characterized by paroxysmal or sustained HTN; almost always d/t tumor of the adrenal medulla**

20
Q

Pheochromocytoma S & S

A

labile HTN
-diaphoresis, palpitations, tremor, tachycardia, postural hypotension

sounds like hyperthyroidism
but difference is: hypertension or postural hypotension (not a fx of hyperthyroidism)
labile BP is a tip off

21
Q

pheochromocytoma labs and diagnostics

A
  1. TSH normal** (initial test to order to r/o hyperthyroid)
  2. -plasma-free metanephrines**
    a. plasma concentration of normetanephrine > 2.5 pmol/ml OR
    b. Metanephrine levels > 1.4
  3. -assay of urine catecholamines (total and fractionated), metanephrines, vanillylmandelic acid (VMA) and crt. 24 hr urine > 2.2 metanephrine per mg cry AND > 5.5 VMA per mg crt AND > 5.5 ug VMA per crt (test to order in the outpatient setting)*
    - CT of adrenals used to confirm     and localize tumor
22
Q

Pheochromocytoma management

A

Surgical removal of tumor is treatment of choice.

  • adrenal adrenergic meds used preoperatively
  • postoperatively watch for: hypotension (depleted catecholamines), adrenal insufficiency(hypotension), hemorrhage

post op- watch for hypotension and hemorrhage

23
Q

steroids cause..:(adrenocorticotropic hormone) cortisol, cortisone, steroid…

A

transplant patients receive steroids often

  • mobilization of breakdown of fat and mobilizes from periphery to abdomen
  • suppress inflammatory response
  • prevent uptake of glucose by cell (DM picture)
  • vasoconstriction (hypertensive in cushing’s)
24
Q

aldosterone and androgen deficiency

A

product of aldosterone + androgen = mineralocorticoids.

25
Q

Which elevated laboratory findings would you expect to find with Adrenal Insufficiency?

A

Elevated BUN, low Na, high K

26
Q

How does hyperthyroidism present?

A
  • unintentional weight loss
  • increased sweating
  • palpitations
  • thinning hair
  • thyroid gland that is symmetrically enlarged without nodules but with bruit
  • some present with new onset A-fib
27
Q

Initial management of a patient with lowered TSH levels and increased T4 includes?

A

ppropylthiouracil (PTU) 150mg Q8 hours

28
Q

Grave’s dz is characterized by what?

A
  • menstrual irregularities
  • fatigued and restless
  • weight loss with goiter
29
Q

What are some conditions that predispose people to Cushing’s dz?

A
  • non-small cell lung carcinoma
  • benign pituitary adenoma
  • adrenal neoplasm

adenocarcinoma of breast is NOT risk factor

30
Q

A patient presents with low sodium, high potassium, elevated BUN and hypotension. You suspect Adrenal insufficiency. what PE findings would you expect to find

A

-hyperpigmentation of skin and tachycardia

also hypoglycemia

31
Q

A woman with dx of thyroid storm and elevated temp. How do you treat and how do you not tx?

A

Tx- BB and methimazole

not tx: dont give asprin as fever is most likely d/t hypermetabolic state

32
Q

Acute Adrenal insufficiency is a medical emergency.

Initial management includes:

A

hydrocortisone 50mg q 6 hours IV or 100mg q 8 hours IV x 7 days

33
Q

which lab tests diagnose hypothyroidism

A

Elevated TSH, decreased T3, decreased T4

34
Q

Diagnosis of adrenal insufficiency is not made by what?

A

-antiduretic hormone test (ADH). this test is used to determine cause of ADH deficiencies and excesses not adrenal insufficiency

Endocrine (3 decks)

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