Endocrinology- Adrenal/ Renal

Question 1

Pallor, Tachycardia and hypertension on induction of anesthesia (all else normal)

Answer 1

Concerning for catecholamine sure due to anesthesia–> pheochromocytoma

Question 2

Precipitation of hypertension in pheochromocytoma

Answer 2

HTN can be intermittent end or sustained.

Precipitated by increased intra abdominal pressure, surgical procedures and meds (esp. anesthetic agents)

Question 3

differentiate between alcohol withdrawal and pheochromocytoma

Answer 3

alcohol withdrawal takes longer to manifest and will not manifest under anesthesia

Question 4

management of congenital adrenal hyperplasia

Answer 4

Glucocorticoids and mineralocorticoids

Question 5

S&S congenital adrenal hyperplasia

Answer 5

Ambiguous genitalia in girls

Salt wasting syndrome (after 1wk age)

Question 6

S&S acute adrenal crisis

Answer 6

Shocked, altered mental status, vomiting, abdominal pain, weakness, fatigue

Question 7

S&S primary adrenal insufficiency

Answer 7

Skin hyperpigmentation, 
orthostatic hypotension, 
fatigue, weakness,
muscle aches, 
weight loss, 
GI disturbances
salt craving 
psychiatric manifestations

Question 8

Hormone responsible for hyperpigmentation in PAI

Answer 8

Melanocyte stimulating hormone is consecrated with ACTH

Question 9

Primary vs secondary adrenal insufficiency

Answer 9

secondary aka central is due to suppression of ACTH.

Mineralocorticoid production maintained (RAAS controlled)
No hyperpigmentation
Normal K

Question 10

Electrolyte abnormalities in primary adrenal insufficiency (PAI)

Answer 10

Hyponatremia 
Hyperkalemia 
eosinophilia 
Low morning cortisol 
High ACTH

Question 11

Tx PAI

Answer 11

Glucocorticoids

Mineralocorticoids

Question 12

Evaluation PAI

Answer 12

Morning cortisol
Plasma ACTH
ACTH stimulation test (confirmation)

Question 13

Medication used for ACTH stimulation test

Answer 13

cosyntropin is a synthetic ACTH analog