Darrow, pheo, hirsuitism, aldosteronism Flashcards
43 F uncontrolled HTN, rash on wrist, 4th heart sound, K low, HCO3 high,Mg low
acid base state?
hypokalemic alkalosis
if you are hypokalemic how does that affect insulin
decreases insulin secretion leading to glucose intolerance
what type of DI does hypokalemia cayse
nephrogenic because defective activation of renal adenyl cyclase
why is K drawn slowly without vacutainer
fast will cause hemolysis
alubuterol affects on K
lower serum K by stimulating release of insulin
What stimulates the glomerulosa to produce aldosterone
ANG II and K+
what inhibits glomerulosa
ANP= less aldosterone
what stimulates the fasiculata and reticularis
ACTH
what do you expect renin level to be if aldosterone is high
low because neg feedback
what is the standing up test for aldosterone renin
keep patient upright for 3 hours to cause rise in renin
if the aldosterone: renin ratio>30 it is most likely primary hyperaldosteronism
Conns syndrome
primary hyperaldosteronism
causes of conns syndrome
adrenal ademoa
unilateral or b/l hyperlpasia
genetic defect with overly strong effect of ACTH on aldosterone production
what is a good Dx test for primary aldosteronism
24 hour urine collection for aldosterone (>12 confirmatory)
Na loading before
how do you differentiate adenoma from b/l adrenal hyperplasia
postural sitmulation test
what is postural stimulation test
measure aldosterone while patient laying down then walk around 3 hours and if see rise in aldosterone then responding normal so hyperplasia
an adenoma would not respond
how to Tx patient with adrenal hyperplasia causing primary hyperaldosteronisms
meds- spironolactone
licorice effects on adrenals
inhibits 11betaHSD2 which converts cortisol to cortisone
so allows cortisol to drive mineralocortiocoid R leading to HTN and low renin/aldosterone
increased renin and aldosterone with alkalosis could be what
secondary aldosteronism: diuretics, Bartters and Gitelman,
vomiting
nasogastric suction
what are causes of pseudohyperaldosteronisms
liddles
cushings exogenous steroids
CAH
licorice
renin and aldosterone levels in pseduohyperaldosteronism
both decreased
What is liddles syndrome
gain of function in Na channel which inc K secretion and dec aldosterone and renin
pseudohyperaldosteronism
22 y.o F with acne, hirsutism, irregular menses,, acanthosis nigricans and apple shape
lab show inc testosterone with normal DHEA and 17OHP
next test
FSH LH
LH/FSH >2 22 y.o F with hirsutism
problem with follicular cell development in ovaries, Polycycstic ovary syndrome
majority of hirsutism is caused by what
decreased sex hormone binding globulin (increased free testosterone)
