Endocrine - Adrenal

Question 0

Signs/Synptoms of Cushing’s syndrome?

Answer 0

#Fat redistribution – moon face, truncal obesity, buffalo hump
#Skin – striae, easy bruising, thinning
#Bone – osteoporosis
#Hypertension (from increased sodium resorption and vasoconstriction)
#GU – menstrual disorders or erectile dysfunction
#renal – polyuria from hyperglycemia and increased Freewater clearance

Question 1

Cushing’s syndrome versus Cushing’s disease?

Answer 1

Hypercortisolism versus pituitary overproduction of ACTH

Question 2

Best initial test for hypercortisolism? Also can use?

Answer 2

24 hour urine cortisol

Overnight dexamethasone suppression test

Question 3

Causes of false positives on dexamethasone suppression test?

Answer 3

#Depression
#Alcoholism
#Obesity

Question 4

Best initial tests to determine the source/location of hypercortisolism?

Answer 4

ACTH level

If elevated, do high dose dexamethasone test (Suppression indicates pituitary source, non-suppression indicates ectopic production)

Question 5

Patient presents with signs of hypercortisolism. ACTH is elevated and does not suppress with high dose of dexamethasone – next step? If still unclear, perform? If that is negative?

Answer 5

MRI for pituitary lesion

Petrosal sinus sampling for elevated ACTH (for pituitary lesions too small to be detected by MRI)

CT Chest for masses

Question 6

Electrolyte and metabolic effects of hypercortisolism?

Answer 6

#Hyperglycemia
#hyperlipidemia
#Hypokalemia
#Metabolic alkalosis

Question 7

CT shows unexpected incidentaloma on the adrenal gland – work up?

Answer 7

#Renin/aldosterone levels to exclude hyperaldosteronism (salt)
#Dexamethasone suppression test (sugar)
#DHEA-S (sex)
#Metanephrines (medulla)

Question 8

Adrenal crisis versus Addison’s disease?

Answer 8

Acute versus chronic hypoadrenalism

Question 9

Addison’s disease is most commonly caused by? Other classes?

Answer 9

Autoimmune destruction

#Infection (tuberculosis, histoplasmosis, coccidiosis)
#Adrenoleukodystrophy
#Metastatic cancer

Question 10

Acute adrenal crisis is caused by?

Answer 10

#Surgery
#Hypertension
#sudden removal of chronic steroids

Question 11

Presentation of acute/chronic hypoadrenalism?

Sign of chronic adrenal insufficiency?

Answer 11

#Altered mental status
#Anorexia, nausea/vomiting
#Hypotension

Hyperpigmentation

Question 12

Lab findings in hypoadrenalism?

Answer 12

#Hypoglycemia
#Hyperkalemia
#metabolic acidosis 
#Hyponatremia
#High BUN
#Eosinophilia

Question 13

Most specific test of adrenal function?

Answer 13

Cosyntropin stimulation test

Question 14

Management for acute adrenal crisis?

Answer 14

Treating adrenal crisis > finding etiology

#Hydrocortisone
#Fludrocortisone (mineralocorticoids) if postural instability

Question 15

Most likely causes of primary hyperaldosteronism? And treatment?

Answer 15

Solitary adenoma (resection) >bilateral hyperplasia (spironolactone/eplerenone)

Question 16

When to suspect secondary hypertension?

Answer 16

#Patient under 30 or over 60
#Hypertension not controlled by two antihypertensives
#low K (muscle weakness or diabetes insipidus)

Question 17

Suspect primary hyperaldosteronism – best initial test? Most accurate test?

Answer 17

Renin/Aldosterone ratio

Venous blood sampling

Question 18

MIBG scanning?

Answer 18

Nuclear isotope scan to locate pheochromocytoma originating outside of adrenal gland

Question 19

Treatment for pheochromocytoma?

Answer 19

Phenoxybenzamine (alpha blocker). Then calcium channel blocker and beta blocker.

Eventfully surgery