Endocrine Disorders Flashcards

1
Q

Give 3 examples of adrenal steroids

A

Mineralocorticoids (aldosterone)

Glucocorticoids (cortisol)

Adrenal androgens

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2
Q

What are 2 types of adrenal hyper function?

A

Excess cortisol (Cushing’s)

Excess aldosterone (Conns syndrome)

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3
Q

What are 2 types of adrenal insufficiency?

A

Hypocortisolism

Lack of aldosterone and cortisol (Addisons)

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4
Q

What is aldosterone secretion activated by?

A

RAAS

Increased plasma [K+]

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5
Q

How is RAAS activated?

A

Reduced renal perfusion

Increased sympathetic activity

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6
Q

What can be used to diagnose primary hyperaldosteronism?

A

Aldosterone:Renin ratio is useful in diagnosis

Source of excess aldosterone is adrenal

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7
Q

What effects does cortisol have on metabolism and other targets of cortisol action?

A

Brain

Bone

Cardiovascular system

Immune system

Kidney

Fetus

Skin/connective tissue

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8
Q

What causes Cushing’s disease?

A

Iatrogenic
- excess ACTH secretion

  1. Exogenous glucocorticoids activate cortisol receptor
  2. At high doses will shut down HPA
  3. Adrenal cortex atrophies with lack of ACTH stimulation
  4. Several days may be required for adrenal to become response to ACTH again
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9
Q

Describe the differential diagnosis of Cushing’s syndrome

A

Dexamthosone suppression test

Should be suppression with Cushing’s

High plasma ACTH

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10
Q

Describe the differential diagnosis of Ectopic ACTH

A

No suppression with dexamethasone suppression test

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11
Q

What is primary adrenal insufficiency?

A

Addisons disease

Insufficient cortisol and aldosterone

High ACTH and low cortisol

Progressive but can lead to adrenal crisis

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12
Q

What is secondary adrenal insufficiency?

A

Pituitary or hypothalamic disease

Insufficient cortisol

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13
Q

What are the clinical features of Addisons disease?

A

Hypotension

Plasma sodium: normal to low

Plasma pottasium: normal to high

High ACTH

Elevated plasma renin

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14
Q

What dynamic test can help the diagnosis of Addisons disease?

A

ACTH stimulation test- Assess ability of adrenal to produce cortisol in response to ACTH

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15
Q

Describe how to do a shot synthacthen test for ACTH stimulation

A

Measure baseline cortisol

30 minutes after 250 micrograms of synacthen (synthetic ACTH)

Adrenal insufficiency is excluded by an increase in cortisol of >200 or a 30 minute value <550

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16
Q

Describe how to do a long synthacthen test for ACTH stimulation

A

NOT OFTEN NECESSARY since ACTH assay can distinguish

Adrenal cortex “shuts down” in absence of stimulation by ACTH - time needed to regain responsiveness

3 day stimulation by synacthen

In secondary adrenal insufficiency ONLY cortisol increases by >200 mmol/L over baseline