Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endocrinology > Endo 6 - Hyperadrenal Disorders > Flashcards

Endo 6 - Hyperadrenal Disorders Flashcards

1
Q

Describe the effects of excess cortisol on protein and fat synthesis

A

decreased protein synthesis

increased fat synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Explain why people with Cushing’s get stretch marks?

A

Putting on fat very quickly which stretches the skin

protein cannot be synthesised quick enough to replace skin tears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the clinical features of Cushing’s syndrome?

A
  • Moon face
  • interscapular fat pad
  • proximal myopathy
  • easy bruising
  • striae
  • thin skin
  • osteoporosis
  • diabetes
  • centripetal obesity
  • hypertension and hypokalaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What hormone is in excess in Cushing’s?

A

Cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why is there bruising in Cushings?

A

cannot synthesise protein to heal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is proximal myopathy?

A

weakness of limbs - usually lower limbs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why do you get hypertension and hypokalaemia?

A

cortisol binds to receptors on kidney to retain sodium and excrete potassium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the difference between Cushing’s syndrome and disease?

A 
Disease = pituitary tumour
Syndrome = other causes e.g. ectopic lung tumour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Name 4 causes of Cushing’s syndrome?

A

Pituitary adenoma
Ectopic ACTH releasing tumour e.g. lung
Oral glucocorticoid drugs
Adrenal adenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Name 3 tests used to diagnose Cushings

A
  1. 24 hour urine free cortisol
  2. Diurnal blood cortisol level
  3. Low dose dexamethasone suppression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Explain the 24 hour urine free cortisol test

A

normal people will have high cortisol in the morning and then will go down
People with Cushing’s will have high even in the night

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Explain Diurnal blood cortisol level

A

Admit patient, and connect catheter and take a midnight reading of cortisol while the patient is sleeping
normal = low cortisol
cushings = high cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why do you do a diurnal blood cortisol level test while the patient is sleeping?

A

stress of blood test may increase the cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Explain the Low dose dexamethasone suppression test?

A

artificial steroid which will usually cause a suppression of cortisol
normal = low cortisol
cushings = high cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the test to differentiate between Cushing’s disease and Cushing’s syndrome?

A

High dose dexamethasone test
disease = low cortisol as will be inhibited in pituitary
syndrome = still high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the two surgeries for cushing’s syndrome?

A

If disease = transphenoidal hypophysectomy

if syndrome = bilateral adrenalectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

State 2 drugs used to treat Cushing’s before surgery?

A

Metyrapone + Ketoconazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which enzyme is inhibited by metyrapone?

A

11-hydroxylase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How does metyrapone work?

A

prevents the conversion of 11-deoxycortisol to cortisol so less cortisol

20
Q

Why is this given to patients before surgery?

A

As too much cortisol = hypertensive so need to control that before surgery

21
Q

What hormone accumulates with the use of metyrapone?

A

11-deoxycorticosterone and 11 deoxycortisol

11-deoxycortisosterone has mineralcorticoid properties
which causes sodium retention and potassium excretion - hypertensive

also hormones funnelled towards sex steroids so causes hirsuitism in women

22
Q

Is metyrapone good for short term or long term?

A

Short term only to prepare for surgery

23
Q

What class of drug is ketoconazole?

A

Anti-fungal

24
Q

Why was it withdrawn in 2013?

A

Hepatotoxicity

25
Q

How does ketoconazole work?

A

Inhibits cytochrome p450
so stops the conversion of cholesterol –> pregnenalone
so stops the production of all steroids

26
Q

What are the unwanted side effects of ketoconazole?

A

alopecia, oligospermia, impotence, liver damage

27
Q

What is Conn’s syndrome?

A

Too much aldosterone

28
Q

Where is aldosterone produced?

A

Adrenal gland - zona glumerulosa

29
Q

What is Conn’s syndrome caused by?

A

Benign adrenocortical tumour

30
Q

What are the two main features of Conn’s syndrome?

A
  • High BP

- Low potassium

31
Q

What is primary hyperaldosteronism?

A

adrenal adenoma causing hyperaldosteronism

32
Q

What tests would you do to diagnose Conn’s syndrome?

A

measure aldosterone - high

measure renin - will be low

33
Q

Why would the renin-angiontensin system be suppressed in Conn’s syndrome?

A

High blood pressure will suppress it

34
Q

What is the medical plan for someone with Conn’s?

A

Medical treatment - spironolactone

Surgery to remove tumour

35
Q

What class of drug is spironolactone?

A

aldosterone receptor antagonist

36
Q

How does spironolactone work?

A

Blocks the receptor so you get decreased sodium reabsorption and decreased potassium excretion

37
Q

What is the active metabolite of spironolactone?

A

Canrenone

38
Q

What is the treatment of bilateral adrenal hyperplasia?

A

Lifelong spironolactone

39
Q

Why would you not remove both adrenas for someone with bilateral adrenal hyperplasia?

A

wouldn’t produce any cortisol or aldosterone

40
Q

What are the side effects of spironolactone?

A
  • menstrual irregularities
  • gynaecomastia in men
  • GI tract irritation
  • contraindicated in renal and hepatic disease
41
Q

What is another mineralcorticoid receptor antagonist?

A

Eplerenone

42
Q

What is phaeochromocytoma?

A

tumour of adrenal medulla producing excessive amounts of catecholamine e.g. adrenaline and noradrenaline

43
Q

What are the symptoms of phaeochromocytoma?

A

Episodic severe hypertension

44
Q

What are some of the fatal consequences of phaeochromocytoma?

A

MI and stroke

45
Q

Why do you get episodic severe hypertension?

A

adrenal medulla releases bursts of adrenaline

may happen after palpation of abdomen

46
Q

How do you prepare a phaeochromocytoma patient for surgery?

A
  • alpha blocker
  • beta blocker
  • fluid
47
Q

What percentage of phaeochromocytoma is intra-adrenal?

A

90%

Endocrinology (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions