Endocrine 5 Flashcards

1
Q

Conn’s Syndrome:

Primary Hyperaldosteronism is a rare disease that is typically caused by an adenoma of the _________ (70% of cases), whereas the remaining 30% have cortical hyperplasia.

A

Zona Glomerulosa

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2
Q

Clinical presentation of which condition?

retention of sodium and loss of potassium, accompanied by retention of water, resulting in hypertension (hypernatremic hypokalemic hypertension)

A

Conn’s Syndrome

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3
Q

How is Conn’s Syndrome treated?

A

Tx is surgery with complete cure

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4
Q

_________ is much more common than primary (Conn’s)

where the secretion of Aldosterone is physiologically stimulated by angiotensin (formed from angiotensinogen under the influence of renin)

A

Secondary Hyperaldosteronism

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5
Q

Secondary Hyperaldosteronism-

Renin is secreted from the _____ cells of the kidneys, and elevated levels of renin are typically found in various renal diseases.

A

J-G cells

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6
Q

Secondary Hyperaldosteronism is associated with ________, in contrast to primary (AKA Conn’s syndrome), which is renin-independent and associated with normal levels of renin in the circulation.

A

hyperreninemia

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7
Q

Is Conn’s syndrome renin independent or dependent?

A

Renin independent

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8
Q

How do you determine whether hyperaldosteronism is caused by renal or adrenal disease?

A

Blood test

(b/c renin and aldosterone measurements are in the blood)

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9
Q

Adrenogenital syndrome (Adrenal Virilism) is a rare disease that can affect _______ or ______

A

neonates or adults

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10
Q

The disease is typically found in______ (males or females) who experience what?

A

Females

who experience virilization due to an excess of adrenogenic hormones.

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11
Q

Which syndrome?

May be congenital or may develop in adulthood

In neonates, the disease is related to one of several inborn errors of steroid metabolism (i.e. 21-hydroxylase deficiency) that causes an overproduction of testosterone

A

Adrenogenital syndrome (Adrenal Virilism)

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12
Q

Which syndrome?

An excess in Androgens results in partial virilization of the external female genitalia causing:

  1. enlargement of the clitoris
  2. partial fusion of the labioscrotal folds.
A

Adrenogenital syndrome

(although they are genetically female, they are sometimes reared as males)

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13
Q
A
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14
Q

In adult women, Adrenogenital syndrome is related to _________

A

androgen producing tumors

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15
Q

Adrenogenital syndrome causes what 4 sxs in adult women?

A
  1. virilization
  2. hirsuitism
  3. deepening of the voice
  4. loss of menstruation
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16
Q

Adrenogenital syndrome-

what is treatment of adrenocortical hyperfunction

A

depends on the cause of the disease

usually involves surgical resection of hyperfunctioning tumors.

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17
Q

Adrenocortical hypofunction is usually a consequence of what 2 things

A

consequence of adrenal destruction:

  1. either acutely (Waterhouse-Freidreichsen’s Syndrome) OR
  2. slowly, owing to destruction of the adrenocortex by an autoimmune disease (Addison’s Disease)
18
Q

Infections (TB or Histoplasmosis), primary or metastatic malignancies (Lung or Breast) may also destroy the adrenals, causing

A

insufficiency

19
Q

Which dz accounts for the vast majority (70-80%) of adrenal insufficiency today

A

Addison’s Disease

20
Q

Addison’s Disease accounts for the vast majority (70-80%) of adrenal insufficiency today, the remaining are still due to________, that affect the immunosuppressed (AIDS).

A

infections, such as TB or fungal diseases

21
Q

T/F: malignant tumors are a common cause for Addison’s

A

FALSE
they are a rare cause for Addisons

23
Q

Pathologically, the adrenal in Addison’s, early on, is characterized in infiltration of ______ and_______ in the cortex.

A

lymphocytes and plasma cells

24
Q

Addison’s disease- In later stages, the entire cortex is destroyed and may be replaced by _______ or fat cells.

A

fibrous tissue

25
Clinically, Addison’s Disease presents with what 3 things? Affected patients are hypotensive.
1. Fatigue 2. Weight loss 3. Nausea (note that this is opposite from Cushing's)
26
What is the name of the neoplasm of the adrenal medulla that synthesize and release Catecholamines (Epinephrine and Norepinephrine).
Pheochromocytoma
27
Pheochromocytoma: Although uncommon, they give rise to a surgically correctable form of \_\_\_\_\_.
HTN
28
Pheochromocytoma- ## Footnote •\_\_\_\_% are bilateral and \_\_\_\_\_% may arise from other sites (i.e. carotid body) where they are called Paragangliomas.
10% and 10%
29
Pheochromocytomas range from small, circumscribed lesions confined to the adrenal to \_\_\_\_\_\_\_\_
large hemorrhagic masses.
30
* They are tan-yellow, well-defined lesions that compress the adjacent adrenal, with varying amounts of hemorrhage. * The larger lesions tend to have necrosis and large areas of hemorrhage.
Pheochromocytoma
31
Pheochromocytoma- ## Footnote •The diagnosis of \_\_\_\_\_\_\_, which occurs in about 10% of pheochromocytomas, is based on the presence of\_\_\_\_\_\_\_.
malignancy, metastasis
32
Pheochromocytoma metastases may involve _________ as well as more distant sites, such as liver, lungs and bone.
regional lymph nodes
33
pheochromocytoma metastases involve which 3 distant sites?
1. liver 2. lungs 3. bone
34
Dominant clinical manifestation is HTN, which is: 1. abrupt, 2. with tachycardia, 3. palpitations, 4. H/A, 5. sweating 6. tremor, 7. often associated with N/V, abdominal, and chest pain.
Pheochromocytoma
35
What would you be concerned about if a patient is complaining of paroxysmal HTN _only_ w/ exercise?
**Pheochromocytoma** | (just bending over can irritate pheo)
36
in how many patients w/ a pheochromocytoma does the hypertension occur in the form of chronic, sustained elevations in blood pressure.
2/3
37
in 1/3 of patients w/ pheochromocytoma, the HTN paroxysms may be precipitated by what 3 things?
1. stress 2. exercise 3. change in posture
38
the elevations in blood pressure of a person w/ a pheochromocytoma are induced by what?
the sudden release of catecholamines.
39
Pheochromocytoma- the sudden release of catecholamines may acutely precipitate what 5 thngs
1. pulmonary edema 2. MI 3. V-fib 4. CVA 5. CHF
40
In some cases, pheochromocytomas secrete other hormones, such as ______ and \_\_\_\_\_\_\_ may therefore be associated with clinical features related to these hormone secretions.
ACTH and Somatostatin
41
The lab diagnosis of pheochromocytoma is based on the demonstration of what?
increased urinary excretion of free catecholamines and their metabolites, such as **Vanillylmandelic Acid (VMA’s)** and **Metanephrines.**
42
Pheochromocytoma- isolated benign tumors are treated with what?
surgical excision after pre-operative and intraoperative medication with adrenergic blocking agents.