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Clinical Medicine II > Endocrine: Adrenal Disorders > Flashcards

Endocrine: Adrenal Disorders Flashcards

1
Q

High ACTH, High Cortisol indicates…

80% of cases

A

Cushings disease (ACTH hypersection)&raquo_space;> non-pituitary tumor (ACTH dependent)

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2
Q

ACTH Low, Cortisol High indicates…

20% of cases

A

Iatrogenic/factitious Cushings Syndrome (excess exogenous GC)

malignancy (ACTH independent)

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3
Q

Gold standard dx for cushings…

A

24 Hour Urinary Free Cortisol Excretion = Gold Standard

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4
Q

4 imaging modalities to evaluate cushings…

A

MRI (r/o pituitary tumor)

CXR (r/o lung mass)

Pelvic US (r/o ovarian mass)

CT abdomen (r/o adrenal tumor)

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5
Q

Besides 24 hour urinary free cortisol excretion, what two labs can be used to dx cushings?

A

Late-Night Salivary Cortisol

Low-Dose Dexamethasone Suppression Test

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6
Q

A Low-Dose Dexamethasone Suppression Test: Cortisol > ______ mcg/dL =

A

5mcg/dL

abnormal, ACTH-independent

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7
Q

What is the protocol for low-dose dexamethasone suppression test?

A

measure baseline 8am cortisol

administer 1 mg dexamethasone at 11pm

measure serum cortisol 8 am next day

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8
Q

What is the 1st line tx for cushings absent a specific etiology?

A

Ketoconazole (1st Line), +/- Metyrapone, Mitotane (medical adrenalectomy)

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9
Q

1st line for cushings due to Exogenous CS

A

taper to lowest therapeutic dose

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10
Q

1st line for cushings due to Pituitary Adenoma

A

transsphenoidal resection

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11
Q

1st line for cushings due to Adrenal Tumor

A

adrenalectomy

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12
Q

1st line for cushings due to …
Adrenal hyperplasia
inoperable tumor
other malignancy

A

Ketoconazole (1st Line) +/- Metyrapone, Mitotane (used for medical adrenalectomy)

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13
Q

A patient presents with…

amenorrhea
Striae, Hyperpigmentation
Moon Face & Buffalo Hump
HTN
Osteoporosis
A

Cushings

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14
Q

Hyperaldosterone has what effect on potassium?

A

↓ Serum K+

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15
Q

Bilateral Idiopathic Adrenal Hyperplasia is the most common cause of…

A

Conn’s Syndrome/Primary Hyperaldosteronism

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16
Q

30% of cases of Conn’s Syndrome/Primary Hyperaldosteronism are caused by…

A

unilateral aldosterone-producing adenoma

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17
Q

a patient presents with…

HTN
Hypokalemia
weakness
paresthesia
HA
polyuria
polydipsia
A

Conn’s Syndrome/Primary Hyperaldosteronism

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18
Q

3 labs to dx Conn’s Syndrome/Primary Hyperaldosteronism

A

↑ Plasma Aldosterone Concentration (PAC)

↓Plasma Renin Activity (PRA)/Plasma Renin Concentration (PRC)

Spontaneous Hypokalemia

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19
Q

Who should be tested for Conn’s Syndrome/Primary Hyperaldosteronism

A

HTN + Comorbidities

FHx

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20
Q

What imaging can assess for

Conn’s Syndrome/Primary Hyperaldosteronism?

A

CT Abdomen

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21
Q

Conn’s Syndrome/Primary Hyperaldosteronism caused by Unilateral Adrenal Adenoma is treated how?

A

surgery

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22
Q

Conn’s Syndrome/Primary Hyperaldosteronism caused by Bilateral Idiopathic Adrenal Hyperplasia is treated how?

A

Spironolactone + antihypertensives

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23
Q

Conn’s Syndrome/Primary Hyperaldosteronism being treated medically should include monitoring of (3) during the 1st 4-6 weeks…

A

K+, Cr, BP

24
Q

↓ synth of all adrenocortical hormones

A

Addison’s Disease/Primary Adrenocortical Insufficiency

25
Q

The below indicates…

↓ Cortisol, ↓ Aldosterone, ↓ Androgens

↑ ACTH, ↑ CRH

A

Addison’s Disease/Primary Adrenocortical Insufficiency

26
Q

What is the MC cause of addison’s?

A

Autoimmune Destruction of Adrenal Cortex

27
Q

The below presentation is concerning for…

Hyperpigmentation
salt craving
postural hypotension

A

Addison’s/primary adrenocortical insufficiency

28
Q

What are 2 diagnostics for addison’s/primary adrenocortical insufficiency?

A

Serum AM Cortisol

Cosyntropin (ACTH) Stimulation Test

29
Q

These labs are helpful adjuncts for diagnosing…

ACTH, Renin, Aldosterone, Anti-Adrenal Abs, CMP, CBC

A

addison’s/primary adrenocortical insufficiency

30
Q

What is the protocol for Cosyntropin (ACTH) Stimulation Test

A

draw baseline cortisol

administer bolus of cosyntropin

repeat cortisol q 30 min and 60 min

31
Q

With Cosyntropin Stimulation Test, Abnormal Result is Cortisol fails to increase by _____ above baseline, or to _____

A

increase 7 mg/dL

or to > 18 mcg/dL

32
Q

Three treatment options for addison’s?

A

hydrocortisone BID/TID

OR

Dexamethasone/predisone

OR

Fludrocortisone

+/- DHEA (women)

33
Q

The presentation of Secondary/Tertiary Adrenocortical Insufficiency lacks what two addison’s signs/sxs?

A

Normal aldo, no hyperpigmentation

34
Q

The below indicates…

↓ Cortisol, ↓ Androgens, ↓ ACTH

Normal Aldo

↑ CRH

A

Secondary adrenocortical insufficiency

35
Q

The below indicates…

↓ Cortisol, ↓ Androgens, ↓ ACTH, ↓ CRH

Normal Aldo.

36
Q

What is the MC cause of secondary/tertiary adrenocortical insufficiency?

A

Exogenous Steroid Use

37
Q

What is a most commonly benign tumor arising from the chromaffin cells in the adrenal medulla

A

pheochromocytoma

38
Q

A patient with the below S/S is concerning for…

Episodic HA, Tachycardia, Sweating + paroxysmal HTN

39
Q

The below can be found in…

Abdominal mass
adrenal mass
MEN2
neurofibromatosis

40
Q

Three diagnostic tests used in pheo…

A

Plasma Metanephrines

24-hr Urine (Catecholamines, Metanephrines, VMA)

Clonidine Suppression Test

41
Q

What result of Clonidine Suppression Test is abnormal?

A

no reduction of catecholamines after clonidine admin.

42
Q

What labs may serve as an adjunct to pheo dx? (4)

A

Thyroid Function Tests
Plasma/Urine
Catecholamines
Plasma Epi/NE

43
Q

What imaging is helpful in dx pheo?

A

non contrast CT abd.

44
Q

What is the progression of tx for pheo?

A

Chemical Sympathectomy → Surgical Excision/Adrenalectomy (definitive tx)

45
Q

Low cortisol, low ACTH
+
exaggerated and prolonged ACTH response on CRH stimulation test

A

tertiary adrenal insufficiency

steroid use, hypothalamus

46
Q

Low cortisol, low ACTH
+
absent/subnormal ACTH response on CRH stimulation

A

secondary adrenal insufficiency

steroid use, pituitary

47
Q

What drugs are used as “chemical sympathectomy”?

A

Phenoxybenzamine: pure alpha blocker

Propranolol

48
Q

adrenal mass > 1cm incidentally found

A

adrenal incidentaloma

49
Q

What are two important questions to answer with adrenal incidentaloma?

A

is it functioning?

is it malignant?

50
Q

What must be ruled out in all cases of adrenal incidentaloma?

A

pheo, subclinical cushings

51
Q

If adrenal incidentaloma + HTN, r/o…

A

primary hyperaldosteronism

52
Q

If adrenal incidentaloma + known malignancy elsewhere…

53
Q

If negative workup and adrenal incidentaloma is < 2 cm how often should imaging and dexamethasone suppresson be repeated?

A

imaging q 6 mo

dexamethasone suppression q annually x 4 years

54
Q

If negative workup and adrenal incidentaloma is 2+ cm, what should be considered?

A

surgical resection

55
Q

This test is for…

low dose dexamethasone suppression test

56
Q

This test is for…

cosyntropin stimulation test

A

addison’s

57
Q

This test is for…

clonidine suppression test

Clinical Medicine II (31 decks)

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