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Endocrine > Cushings > Flashcards

Cushings Flashcards

1
Q

ACTH independent cushings is?

A

ppl who are taking exogenous steroids

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2
Q

ACTH dependent cushings is?

A

endogenous causes

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3
Q

90% of ACTH-dependent cushings is caused by?

A

pituitary issues

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4
Q

does ectopic ACTH or Cushings disease cause more elevated ACTH?

A

ectopic ACTH

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5
Q

first step to dx cushings

A

confirm hypercortisolemia

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6
Q

test for cushings should be done inpatient or outpatient

A

outpatient (less stress)

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7
Q

tests for hypercortisolemia (3)

A
  1. 24 hr urine collection - cortisol
  2. 11 pm salivary or serum cortisol
  3. low dose dexamethasone suppresion test
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8
Q

24 hr urinary free cortisol under 50, risk of cushings?

A

unlikely

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9
Q

24 hr urinary free cortisol 50-150, risk of cushings?

A

possible

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10
Q

24 hr urinary free cortisol >150, risk of cushings?

A

likely

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11
Q

does a normal 24 hr urinary free cortisol r/o cushings?

A

no

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12
Q

what is pseudo cushings

A

elevated cortisol levels from an underlying cause that stimulates HPA

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13
Q

best test to do for pseudo cushings?

A

overnight low dose DST

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14
Q

the midnight salivary test result of _______r/o cushings

A

under 5

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15
Q

the midnight salivary test result of _______indicates possibility of cushings

A

5-7.5

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16
Q

the midnight salivary test result of _______likely points to cushings

A

> 7.5

17
Q

dexamethasone suppression test ____ is normal

A

under 2

18
Q

dexamethasone suppression test ____ is suspicious of cushings

A

3-10

19
Q

dexamethasone suppression test ____ is likely cushings

A

> 10

20
Q

how to subtype a case of cushings

A

measure ACTH

21
Q

how to image a pituitary lesion

A

MRI

22
Q

to to image an adrenal lesion or ectopic lesion

A

CT

23
Q

next step in w/u of high cortisol, low ACTH

A

CT to differentiate unilateral vs bialteral disease

24
Q

tx of ACTH-independent cushings - adrenal adenoma

A

surgery + post-op tx of adrenal insufficiecy

25
Q

ACTH dependent cushings - tests to differentiate b/w pituitary vs ectopic (2)

A
  1. inferior petrosal sinus sampling

2. high dose dexamethasone test

26
Q

if patient shows no suppression with high dose dexamethasone test?

A

ectopic

27
Q

if patient shows some suppresion of ACTH with high dose dexamethasone

A

pituitary cause

28
Q

inferior petrosal sinus:peripheral concentration of ACTH >2:1 then?

A

pituitary source

29
Q

most common type of pituitary irradiation

A

stereotactic radiosurgery/gamma knife

30
Q

MOA: blocks conversion of cholesterol to pregnenolone

A

aminoglutethimide

31
Q

MOA: blocks 11 beta hydroxylase

A
  1. ketoconazole

2. mitotane

32
Q

a large adrenal adenoma would dictate what type of surgery

A

open laparatomy & right adrenalectomy

Endocrine (31 decks)

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