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Z Year3 Conditions > ENDO > Flashcards

ENDO Flashcards

1
Q

What is Addison’s disease?

A

primary adrenal insufficiency

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2
Q

What happens in Addison’s disease?

A

destruction of adrenal cortex leads to cortisol and aldosterone decrease

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3
Q

What are the causes for Addison’s disease?

A

80% autoimmunity and long term steroid therapy (happens when withdrawal) in hypo

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4
Q

What are the risk factors for Addison’s disease?

A
  1. Female sex
  2. Presence of adrenocortical autoantibodies
  3. Adrenal Haemorrhage
  4. Use of anticoagulants 5. TB
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5
Q

What are the symptoms of Addison’s disease?

A
  1. Fatigue (described as weakness or tiredness)
  2. Anorexia
  3. Weight loss
  4. Nausea
  5. Vomiting
    (hard to diagnose as vague)
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6
Q

What are the signs of Addison’s disease?

A
  1. Hyperpigementation (sun exposed areas- 95% of people) – due to high ACTH
  2. Hypotension
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7
Q

What are some differential diagnosis of Addison’s disease?

A
  1. Adrenal suppression due to corticosteroid therapy
  2. Secondary or tertiary adrenal insufficiency (pituitary or hypothalamic lesions)
  3. Haemochromatosis
  4. Hyperthyroidism
  5. Occult malignancy
  6. Anorexia nervosa
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8
Q

What are the complications of Addison’s disease?

A
  1. Secondary Cushing’s syndrome
  2. Osteopenia/osteoporosis
  3. Treatment related hypertension
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9
Q

What are the investigations and consequential findings in Addison’s disease?

A
  1. Serum Electrolytes low sodium, high potassium (rarely elevated calcium)
  2. Blood Urea (may be elevated)
  3. FBC: anaemia present in 40% of patients + eosinophilia
  4. Morning serum cortisol: between 9am and 9am <83
  5. ACTH stimulation test
  6. Low glucose due to low cortisol
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10
Q

How do you treat an Addison’s crisis?

A
  1. Glucocorticoid and supportive therapy

- hydrocortisone sodium succinate: 50-100 mg intravenously every 6-8 hours for 1-3 days

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11
Q

How do you treat ongoing Addison’s disease?

A

Glucocorticoid plus mineralocorticoid

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12
Q

What are the options for glucocorticoid?

A
  1. cortisone: 10 to 37.5 mg/day orally given in 2 divided doses with two-thirds of the total dose given in the morning (around 8 a.m.) and one third in the afternoon (noon to 4 p.m.)
  2. hydrocortisone: 15-30 mg/day orally given in 2 divided doses with two-thirds of the total dose given in the morning (around 8 a.m.) and one third in the afternoon (noon to 4 p.m.)
  3. prednisolone: 2.5 to 5mg orally once daily
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13
Q

What mineralocorticoid is given?

A

Fludrocortisone: 0.1-0.2mg orally once daily

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14
Q

What is the prognosis for Addison’s disease?

A
  • Should have medical alert or bracelet and syringes of hydrocortisone (100mg) incase of emergency or trauma
  • Yearly Us+Es and BP
  • Look for other autoimmune (pernicious aneamia)
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15
Q

What is Cushing’s syndrome?

A

clinical manifestation of pathological hypercortisolism from any cause

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16
Q

What are the risk factors for cushing’s syndrome?

A
  1. Exogenous corticosteroid use
  2. Pituitary or adrenal adenoma (endo)
  3. Adrenal carcinoma (endo)
17
Q

What are the symptoms of cushing’s syndrome?

A
  1. Facial plethora
  2. Supraclavicular fullness
  3. Violaceous stria
  4. Absence of pregnancy
  5. Menstrual irregularities
  6. Absence of malnutrition
  7. Absence of alcoholism
  8. Absence of physiological stress
  9. Linear growth deceleration in children
  10. female sex
  11. hypertension (pseudohyperaldosteronim)
  12. glucose intolerance or diabetes mellitus
  13. premature osteoporosis or unexplained fractures
  14. weight gain and central obesity
  15. acne
  16. psychiatric symptoms
  17. decreased libido
  18. easy bruisability
  19. weakness
  20. facial rounding
  21. dorsocervical fat pads
18
Q

What are the differential diagnosis for cushing’s syndrome?

A
  1. Obesity

2. Metabolic syndrome

19
Q

What are the complications of cushing’s syndrome?

A
  1. Adrenal insufficiency secondary to adrenal suppression
  2. cardiovascular disease
  3. hypertension
  4. diabetes mellitus
  5. osteoporosis
  6. nephrolithiasis
  7. Nelson syndrome after bilateral adrenalectomy
  8. treatment-related central
  9. treatment-related growth hormone deficiency variable
  10. treatment-related adrenal insufficiency
  11. surgery- or radiation-related
  12. surgery-related hyponatraemia
  13. treatment-related hypogonadism
  14. treatment-related diabetes insipidus
20
Q

If suspected Cushing’s syndrome what are the investigations and first line test and findings positive for Cushing’s?

A
  1. Midnight salivary cortisol elevated
  2. 1 mg overnight dexamethasone suppression test: morning cortisol >50 nanomol/L (>1.8) micrograms/dL)
  3. 24-hour urinary free cortisol >50 micrograms/24 hour
21
Q

How would you treat Cushing’s syndrome from ACTH secreting pituitary tumour (Cushings disease)?

A

Transsphenoidal pituitary adenomectomy

22
Q

How would you treat cushings’s syndrome from ectopic ACTH or corticotrophin-releasing hormone (CRH) syndrome

A

surgical resection or ablation of tumour and metastases

23
Q

How do you treat cushing’s syndrome from ACTH-independent due to unilateral adrenal carcinoma or adenoma?

A

unilateral adrenalectomy or tumour resection

24
Q

How do you treat cushing’s syndrome from ACTH- independent due to bilateral adrenal disease (hyperplasia or adenoma)

A

Bilateral adrenalectomy and permanent post-surgical corticosteroid replacement therapy

25
Q

What is the prognosis of cushing’s?

A

Untreated cushing’s has high vascular mortality

26
Q

What would you do if the first line test for cushing’s syndrome come back positive?

A
  • ACTH Plasma Levels to figure out cause:
    1. If high: do high dose dex test and if there is no suppression CT for ectopic site and if there is low ACTH MRI pituitary gland OR CRH stimulation test (if no rise, ectopic), (if rise, cushings disease)
    2. If low: non-acth related
27
Q

What other investigations could you do for cushing’s?

A
  1. urine pregnancy test: negative
  2. serum glucose: elevated
  3. 48-hour 2 mg (low-dose) dexamethasone suppression test

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