ENDO 2 Flashcards
Cushing syndrome:
presentation?
↑cortisol → truncal obesity, abd striae, buffalo hump, hyperglycemia, osteoporosis, HTN, immunosuppression
↓ACTH, ↑cortisol =
confirm dx w/ …?
tx?
adrenal Cushing (incr cortisol from adrenal)
dx = abd CT
tx adrenalectomy
On dexamethasone suppression test:
↑ACTH, ↑cortisol, >50% suppression?
confirm dx with…?
tx?
Pituitary Cushing (incr ACTH from Pituitary)
MRI of head
transsphenoid hypophysectomy
On dexamethasone suppression test:
↑ACTH, ↑cortisol, <50% suppression?
confirm dx with…?
Ectopic Cushing (incr ACTH from SCLC)
chest/abd CT
*tx underlying cause
Conn's syndrome: pathophys? lab abn? dx? tx?
67% adenoma, 33% hyperplasia → ↑aldosterone
↑Na (HTN), ↓K, ↓H (metabolic alkalosis)
Dx abd CT scan
Tx adrenalectomy (adenoma), spironolactone (hyperplasia)
Adrenal insufficiency: presentation? causes of 1' (Addison's)? dx? tx?
↓cortisol/↓aldosterone → hypoglycemia, HTN, fatigue, hyperpigmentation, weight loss, abd pain
autoimmune (MC US), TB (MC 3rd world), Waterhouse-Friderichsen syndrome (N. meningitidis)
Dx ↓cortisol + ACTH levels (↑ACTH if primary, ↓ACTH if secondary)
Tx glucocorticoid (prednisone) + mineralocorticoid (fludrocortisone)
Congenital adrenal hyperplasia: deficiency? presentation? lab abn? dx? tx?
congenital deficiency of 21α- hydroxylase (MC) or 11β- hydroxylase → hirsutism, virilization
↓Na
↑K
↑H
Dx ↑17-OHP
Tx glucocorticoid (prednisone) + mineralocorticoid (fludrocortisone)
Gastrinoma:
dx?
Gastrinoma triangle?
gastrin levels (500 present); if 200-500, get secretin stimulation test (paradoxical ↑gastrin w/ secretin)
Gastrinoma triangle: neck of pancreas, cystic duct, junction b/t 2nd and 3rd part of duodenum
Glucagonoma:
presentation?
dx?
tx?
↑glucagon → new-onset diabetes + necrolytic migratory erythema
Dx glucose challenge test
Tx resection
Somatostatinoma:
presentation?
tx?
↑SST → triad of gallstones, diabetes, steatorrhea
resection
VIPoma:
presentation?
tx?
“rice water” diarrhea
resection
MEN 1 (Wermer syndrome):
presentation?
tx?
pituitary adenoma, pancreatic endocrinoma (MC gastrinoma), parathyroid hyperplasia
Tx excise parathyroid first (since hypercalcemia can cause ↑gastrin), then gastrinoma, then pituitary adenoma (w/ cabergoline)
MEN 2A (Sipple syndrome):
presentation?
tx?
etiology?
parathyroid hyperplasia, pheochromocytoma, thyroid medullary cancer
Tx excise pheo first (life-threatening)
Etiology: AD ret proto-oncogene
MEN 2B:
presentation?
tx?
etiology?
pheochromocytoma, thyroid medullary cancer, mucosal neuromas, Marfanoid habitus
Tx excise pheo first (life-threatening)
Etiology: AD ret proto-oncogene
T2DM:
tx for fasting glu 240?
lifestyle → metformin or sulfonylurea → add another PO → insulin
insulin
