Endocrine Flashcards

Question

Syndrome of Inappropriate ADH Secretion (SIADH)

Answer 1

Excess secretion of ADH even with subnormal serum osmolality Can not excrete a dilute urine Retain fluids and develop dilutional hyponatremia Usually non-endocrine cause Typical interventions: treat underlying cause and restrict fluids May use diuretics (furosemide) is severe ↓ Na

Answer 2

Manifestations: Apathy, fatigue, muscle weakness, nausea, vomiting, constipation, HTN, cardiac dysrhythmias Dx: ↑ serum calcium and ↑ PTH concentrations

Answer 3

Management: Surgical removal if symptoms Monitor and wait if no symptoms Avoid dehydration

Answer 4

Manifestations: Tetany Latent: numbness, tingling, cramps in extremities, stiff hands and feet Overt: bronchospasm, laryngeal spasm, carpopedal spasm, dysphagia, seizures, photophobia, cardiac dysrhythmias Dx: Positive Chvostek’s and Trousseau’s sign

Answer 5

In acute hypoparathyroidism IV parathormone Chronic: diet high in calcium and low in phosphorus Oral Ca gluconate, aluminum carbonate, vitamin D

Answer 6

Temporarily occlude arterial blood flow with a BP cuff to 20mmHg above the normal systolic pressure for 2-5 minutes. If hand and fingers contract positive.

Answer 7

Tap of the facial nerve just below the temple. The sign is positive if you see nose, eye, lip, or facial muscle twitching.

Answer 8

Acute Adrenal Insufficiency Life-threatening Cortisol and aldosterone needs are greater than the supply Related to stress, trauma, severe infection

Answer 9

``` Autoimmune disease Tuberculosis Fungal lesions AIDS Hemorrhage (Adrenal) Adrenalectomy Radiation ``` ``` Secondary Causes: Pituitary hormones Hypophysectomy High dose pituitary radiation Brain radiation ```

Answer 10

Hormone replacement Hyperkalemia management Hypoglycemia management

Answer 11

``` CMP UA CT MRI ACTH stimulation test (rapid and long) ```

Answer 12

Hydrocortisone - Corrects glucocorticoid deficiency - Florinef maintains electrolyte balance

Answer 13

Adrenal cortex function is inadequate to meet the needs for cortical hormones Primary- Addison's Secondary- lack of ACTH, prednisone withdrawal

Answer 14

Adrenal gland may over secrete one or more of the adrenal hormones Cushings disease or hyperaldosteronism- excessive mineralcorticoid production

Answer 15

Patients with Cushing’s disease (hyper cortisolism) exhibit Problems with nitrogen, carbohydrate and mineral metabolism. Slow turnover is of plasma fatty acids “Buffalo hump” High levels of corticosteroids decrease immunity by destroying lymphocytes. Increased androgen production causes hirsutism

Answer 16

``` Endogenous (Cushing disease) Adrenal hyperplasia Adenoma Carcinomas Exogenous (Cushing Syndrome) -asthma -Autoimmune disorders -Organ transplants -Cancer chemo -Allergic responses -fibrosis ```

Answer 17

24-hour urinary free cortisol level Midnight plasma cortisol and late-night salivary cortisol measurements Low-dose dexamethasone suppression test (LDDST) Dexamathasone-corticotropin-releasing hormone (CRH) test CMP (Increased glucose, sodium. Decreased lymphocyte count, calcium and potassium). U/A CT, MRI

Answer 18

Radiation therapy -Treats pituitary adenomas Surgery -Removal of tumor or pituitary itself Drug therapy Lysodren - Mitotane is used to treat cancer of the adrenal glands. It works by slowing the growth of or killing adrenal gland cells and also decreases the amount of hormones made by the adrenal gland. Elipten- An aromatase inhibitor that produces a state of "medical" adrenalectomy by blocking the production of adrenal steroids. It also blocks the conversion of androgens to estrogens. Elipten has been used in the treatment of advanced breast and prostate cancer. It was formerly used for its weak anticonvulsant properties.

Answer 19

Increased secretion of aldosterone which results in mineralocorticoid excess Most often caused by adrenal adenoma (primary hyperaldosteronism) Elevated levels of angiotensin II are seen in secondary hyperaldosteronism

Answer 20

``` Hypokalemia and elevated BP Headache Fatigue Nocturia Polydipsia Polyuria paresthesia's ```

Answer 21

Treatment goal in patients with primary aldosteronism is to prevent the adverse outcomes associated with excess aldosterone, including hypertension, hypokalemia, renal toxicity, and cardiovascular damage. Surgery for early stage Unilateral adrenalectomy Drug therapy Medication to increase K+ Spironolactone or Eplerenone spironolactone starting dose is 12.5 to 25 mg daily with food dose can be increased every two weeks until the target serum potassium of 4.5 mEq/L is reached. The typical maximum dose is between 100 to 400 mg daily.

Answer 22

Catecholamine producing tumor that arises in chromaffin cells. Occurs in a single lesion on adrenal gland Releases epinephrine and norepinephrine Cause is unknown occur more in women then men. Could be inherited

Answer 23

``` Intermittent episodes hypertension (classic) Headache Sweating Palpitations Impeding doom Drugs may induce hypertensive crisis ```

Answer 24

Tumor of the adrenal gland Usually benign Peak incidence between 40 and 50 Symptoms triad: headache, diaphoresis and palpitations Hypertension and cardiac disturbances common Acute, un-predictable onset with gradual resolution of symptoms 24-hour urine epinephrine

Answer 25

24-hour UA to test for VMA (vanillylmandelic acid) a production of catecholamine metabolism) CT MRI

Answer 26

Surgery- one or both adrenal glands are removed Monitor BP and treat if hypertensive crisis

Answer 27

Profound ↓ K+ and H+ ions, ↑pH and HCO3 Near normal or ↑ Na Universal sign: HTN Dx: Measurement of aldosterone excretion rate after salt loading Renin-aldosterone stimulation test and bilateral adrenal venous samplin

Answer 28

``` Symptoms: Muscle weakness Cramping Fatigue Nonacid urine Polyuria ↑ serum osmolality Polydipsia Arterial HTN ```

Answer 29

Surgical removal Spironolactone for persistent HTN Monitor for fluctuations in adrenal hormones Corticosteroids, fluids, agents to maintain BP and prevent complications Maintain normal serum glucose