Endocrine 1 Flashcards
This is where the pituitary fails to secrete ACTH.
Usually from a hx of exogenous glucocorticoid use.
Secondary adrenal insufficiency
This is the adrenal gland destruction usually from autoimmune or infection.
Patients with have symptoms of hyperpigmentation due to increased ACTH and also orthosstatic hypotension.
Primary adrenocortical insufficiency (Addison dissease)
Addison’s disease shows what on labs?
Elevated ACTH, Hypoglycemia, hyponatremia, hyperkalemia.
How do you test for Addison’s disease?
High dose ACTH (Cosyntropin) test
Adrenal insufficiency if insufficient or absent rise in serum cortisol after ACTH given.
What is the management of Adrenal insufficiency?
Hydrocortisone
This is a sudden worsening of symptoms in an adrenal insufficiency patient precipitated by a stressful event and likely an abrupt withdrawal of glucocorticoids.
Addisonian crisis
How does addisonian crisis present and what is the treatment?
Presents has shock, hyponatremia, hypoglycemia, and hyperkalemia.
TX is isotonic fluids + IV hydrocortisone or Dexamethasone
This is a cortical excess problem.
Likely due to long term high-dose glucocorticoid therapy
In this condition, there is an overproduction of ACTH from the pituitary gland.
Exam shows obesity, roundly shaped faces, buffalo hump, supraclavicular fat pads, thin extremities. Look for skin changes such as purple striae, acanthosis nigricans.
Cushing’s syndrome
How do you diagnose Cushings?
24 hour urine, Baseline ACTH + Highdose Dexamethasone suppression test.
Cushings: increased ACTH +suppression of cortisol on high dose.
What is the management of cushings?
If due to Corticosteroid use: gradual taper
Transsphenoidal resection
Catecholamine secreting adrenal tumor. secretes norepi, epi, and dopamine.
Presents as palpitations, headaches, excessive sweating.
Pheochromocytoma
What is the treatment for pheochormocytoma?
Nonselective alpha-blockade with phenoxybenzamine or phentolamine for 1-2 weeks followed by a BB or CCB.
This is untreated congenital hypothyroidism.
Caused by a lack of maternal iodine intake in developing countries.
Exam shows coarse facial features, macroglossia, umbilical hernia, hypotonia.
Cretinism
This is the isolated increased TSH in patients with little or no symptoms.
Normal free T4
Subclinical hypothyroidism
What is the treatment of subclinical hypothyroidism?
Levothyroxine may be given if TSH is 10mU/L or higher
