End Part 2 Flashcards
Difference between Cushing Syndrome and Disease?
Syndrome = Excess Cortisol
Disease = ACTH producing tumor
Cushing Syndrome is often caused by exogenous steroids. List some physical exam findings
Central obesity with striae
Moon facies
Buffalo hump
Bruising/purpura
Muscle weakness
Thin skin
If you suspect high cortisol levels, what should be done first?
24 hour urine cortisol levels
If 24 hour cortisol is elevated, then what?
Low-dose Dexamethasone suppression test
What will be the result of a Low-dose Dexamethasone suppression test with Cushing Syndrome?
FAILS to suppress cortisol
Once the cortisol fails to suppress with a low-dose dexamethasone test, what should be done next?
Measure ACTH – Is the high cortisol ACTH independent or dependent?
If ACTH is low with high Cortisol, where is the likely source?
Adrenals – get a CT/MRI
If ACTH is high with high Cortisol, what should be done?
High-dose dexamethasone suppression test
If the High-dose dexamethasone suppression test suppresses cortisol, what is the diagnosis?
Pituitary adenoma
If the High-dose dexamethasone suppression test does NOT suppress cortisol, what is the diagnosis?
Ectopic ACTH producing tumor
List as many Cushing syndrome signs as possible
Abdominal obesity with striae
Moon facies
Buffalo hump
Bruising/purpura
Muscle weakness
Thin skin
If you suspect a GH secreting tumor, what should be measured?
IGF-1
If IGF-1 is HIGH, what should be done next?
Glucose suppression test
GH secreting tumors present as Gigantism in children and Acromegaly in adults. What is the treatment options?
Surgery
Somatostatin analogs to (-) GH secretion
Medical treatment for GH tumors?
Somatostatin analogs to (-) GH secretion
ex. Octreotide
What are 2 complications of Acromegaly?
Diabetes
Cardiomyopathy
What are the levels of the Adrenal Cortex and what do they secrete?
GFR
- Glomerulosa –> Aldosterone
- Fasciculata –> Cortisol
- Reticularis –> Androgens
What regulates the levels of the Adrenal Cortex?
Glomerulosa – Angiotensin 2
Fasciculata and Reticularis – ACTH
What is in the Adrenal Medulla?
Chromaffin cells that produce catecholamines Epinephrine and Norepinephrine
What is Adrenal Insufficiency?
Inadequate production of Glucocorticoids +/- Mineralocorticoids
Common causes of Primary Adrenal Insufficiency?
Autoimmune (Addison’s)
TB
Hemorrhage (Waterhouse-Friderichsen)
Describe the lab values with Primary Adrenal Insufficiency
- Low Aldosterone –> High K+
- Low cortisol
- High ACTH
What are the signs of Primary Adrenal Insufficiency?
Fatigue, anorexia, weight loss and skin hyperpigmentation
What causes the skin hyperpigmentation with Primary Adrenal Insufficiency?
High ACTH
If you suspect Primary Adrenal Insufficiency, what test should be done?
Cosyntropin ACTH stimulation test
What will be the result of Cosyntropin ACTH stimulation test with Primary Adrenal Insufficiency?
NO RISE in Cortisol
What is the treatment for Primary Adrenal Insufficiency?
Replace glucocortiocoids +/- mineralocorticoids (fludracortisone)
Secondary/Tertiary Adrenal Insufficiency is due to?
LOW ACTH
What will the lab values be with Secondary/Tertiary Adrenal Insufficiency?
LOW ACTH
- Low cortisol
- Aldosterone, Na and K UNAFFECTED because they are regulated by Angiotensin 2
An Acute Adrenal Crisis is due to abruptly stopping long-term steroids. How may that present?
Confusion
Hypotension
Coma
What is the treatment for an Acute Adrenal Crisis? (2)
Volume resuscitation + STEROIDS
Congenital Adrenal Hyperplasia is due to enzyme deficiencies. What is the most common?
21-hydroxylase
In general, what is present with 21-hydroxylase deficiency?
LOW mineralocorticoids and glucocorticoids
HIGH Androgens
How will 21-hydroxylase deficiency present?
Ambiguous genitalia and hypotension
What marker is specific for adrenals?
DHEA-S
Besides androgens, what will be elevated with 21-hydroxylase deficiency?
17-OHP and Renin!
If 11beta-hydroxylase deficiency is to blame for CAH, how does that differ from 21-hydroxylase?
NO LOW BP – 11-deoxycorticosterone is produced and is able to raise the BP
MEN 1
Pituitary
Parathyroid
Pancreas
MEN 2A
Parathyroid
Pheochromocytoma
Medullary thyroid carcinoma
MEN 2B
Pheochromocytoma
Medullary thyroid carcinoma
Marfanoid habitus
