Friday - Adrenal Path and MEN - Krafts

Question 1

Cushing syndrome is due to what?

Answer 1

Too much cortisol

Question 2

Actions of Cortisol

Answer 2

blood pressure
breaks down bone
suppress inflammation and immune function
gluconeogenesis

bbiig

Question 3

Sx of cushing’s syndrome

Answer 3

hypertension, weight gain
 - habitus (toro, moon face, buffalo hump)
weakness
infections
mental changes

Question 4

Labs for Cushing’s

Answer 4

24 hour cortisol

ACTH level - can be high or low, just shows cause
dexamethasone suppression test - give it and measure cortisol -

Question 5

Pituitary Cushing syndrome happens how

Answer 5

Adenoma that makes ACTH –> cortisol

Question 6

When is the dexamethasone test helpful?

Answer 6

figure out if it’s pituitary adenoma causing the cushings. dexamethasone at high doses with make the tumor stop secreting

adrenal tumor secreting cortisol wouldn’t respond

Question 7

Cushing syndrome due to tumor. Didn’t respond to dexamethasone.
what two things could it be from? how do you distinguish between them?

Answer 7

Adrenal tumor or paraneoplastic (small cell lung carcinoma)

paraneoplastic has rise in ACTH, but it’s like a fake ACTH

Question 8

common cause of hyperaldosteronism

Answer 8

cotical adenoma of the adrenals –> ald –> decrease renin

Question 9

Symptoms of hyperaldoseronism

Answer 9

hypertension

weakness/fatigue

Question 10

lab findings of primary hyperaldoseronism

Answer 10

increased aldosterone
decreased renin
hypernatremia
hypokalemia

Question 11

Secondary hyperaldosteronism labs

due to?

Answer 11

increased renin and aldosterone

decreased blood flow from a renin making tumor

Question 12

what is virilization

Answer 12

a girl that gets swoll and many characteristics like lots of hair.
due to too many androgens

Question 13

Sudden virilization can be from what tumor

Answer 13

adrenocortical carcinoma

- bad prognosis

Question 14

most common hydroxylase deficiency and labs
Cortisol, Aldosterone
Sex seteroids

Answer 14

21 hydroxylase
decreased cort and ald
increased sex steroids

Question 15

name for primary chronic adrenal insufficiency

cause
symptoms

Answer 15

addison’s disease

autoimmune

weakness, hypotension and skin pigmentation

Question 16

waterhouse friderichsen syndrome

Answer 16

It’s a primary adrenal insufficiency
neisseria –> adrenal hemorrhage –> hypotension, shock.
rapid

Question 17

Secondary renal insufficiency due to:

Answer 17

decreased ACTH

• from pituitary insufficiency
• tumor, infection, radiation

Question 18

Pheochromocytoma

cells make:

Answer 18

catecholamines

–> hypertension

Question 19

Symptoms of pheochromocytoma

Answer 19

high BP
headache
sweating
tachycardia
paroxysmal

Question 20

histo of pheochromocytoma

Answer 20

not much
large nuclei
“zellballen” - balls of tumor

Question 21

neuroblastoma is from what
common in what pop
prognosis good if:
lab finding (first aid)

Answer 21

neural crest
children
younger than 18 mo
fewer copies of n-myc
increased dopamine breakdown product in urine (homovanillic acid)

Question 22

histo of neuroblastoma

Answer 22

rosettes (homer-wright)

Question 23

MEN1 also called:

where do you get tumors

Answer 23

Wermer syndrome
parathyroid hyperplasia
 - stones
pancreatic tumors
 - gastrinoma, insulinoma
pituitary adenoma

Question 24

MEN1 gene codes for what?

mutation does what

Answer 24

menin

turns gene off (tumor suppressor gene)

Question 25

MEN2A tumors

Answer 25

medullary thyroid carcinoma
pheochromocytoma
parathyroid hyperplasia

Question 26

MEN2A gene

what kind of receptor
mutation does what?

Answer 26

RET gene mutation
proto-oncogene
tyrosine kinase receptor
turns gene on

Question 27

MEN2B manifestations not seen in 2A

Answer 27

oral

marfanoid looking