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ENRP Exam 2 > HYHO - Newman #2 > Flashcards

HYHO - Newman #2 Flashcards

1
Q

the HPA axis is a neurodendocrine system that controls reactions to _ and regulates _ (X5)

A

stress

digestion, immune system, mood, sexuality, energy

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2
Q

the _ _ _ of the HPA axis helps to regulate the concentration of hormones in the blood thus preventing over or under correction

A

negative feedback system

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3
Q

what zone of the adrenal cortex is responsible for

mineralocorticoids
glucorticoids
sex steroids

A

mineralocorticoids- glomerulosa
glucorticoids- fasiculata
sex steroids- reticularis

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4
Q

short term stress response involves stimulation of the _ via the _ fibers resulting in the release of _

A

adrenal medulla

via preganglionic sympathetic ribers

catecholamines

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5
Q

example of short term stress reponses

A

increased HR
increased BP
glycogen conversion to glucose in the liver and release into the blood
changes in blood flow patterns: decrease digestive system activity and reduced urine output
increased metabolic rate

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6
Q

long term stress response involves _ stimulation from the _, stimulation of the adrenal cortex by _ and release of _ and _

A

CRH stimulation from the anterior pituitary

stumulation of the adnreal cortex by ACTH

and release of mineralocorticoids and glucocorticoids

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7
Q

what are mineralocorticoids? what do they do?

A

aldosterone that leads to retention of sodium and water by the kidneys

increased blood volume and blood pressure

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8
Q

what are the glucocorticoids? what do they do?

A

cortisol they convert proteins and fats to glucose or energy
lead to an increased blood glucose, and suppresion of the immmune system

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9
Q

the renin angiotension aldosterone system is important in the regulation of _ , _ , and _ physiology

A

renal, cardiac, vascular

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10
Q

renin secretion from the kidney is stimulated by?

A

decreased renal perfusion (decreased blood to the kidney) or increase sympathetic anctivity

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11
Q

angiotensiongen is converted to angiotensin I by _

angiotensin I is converted to angiotension II by _

angiotensin II stimulates _ release from the _

A

renin

angiotension converting enzyme

aldosterone

from the adrenal cortex

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12
Q

always _ the genitalial of a newborn baby

A

examine

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13
Q

the most common cause of ambiguous genitalial in a genetically female infant is?

A

congenital adrenal hyperplasia causing virilization of the genitalia

can be life threatening and must be thought of if a baby presents with ambigious geneitalila

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14
Q

what is the common def. in congeital adrenal hyperplasia

what is there an increase of

A

21-hydroylase def (increased testosterone)

increase of the precursor - 17-OH progesterone

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15
Q

symptoms of congeital adrenal hyperplasia in a neonate

A

failure to thrive, recurrent vomiting, dehydration, hypotension, hyponatermia, hyperkalamia, shock

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16
Q

most common cause of congeital adrenal hyperplasia and the effects it has on aldosterone, cortisol, and androgens

A

cause: 21 hydroxylase def

aldosterone: low
cortisol: low
androgens: high

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17
Q

what are the mainstays of an infant in CRISIS due to congeital adrenal hyperplasia

A

hydrocortisone IV or IM (lifesaving)

fluids/glucose

management of hyperkalemia

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18
Q

what is the purpose of mandatory newboen screening

A

the detect potentially fatal or diabling conditions in the newborn before they develop a serious illness

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19
Q

what 3 adrenal gland defects are responsible for primary adrenal insufficiency (addisons disease)

A

adrenal dysfunction/destruction- most common (autoimmune)
adrenal dygenesis (x-linked congential adrenal HYPERplasia)
impaired steroidogensis

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20
Q

primary symptoms of primary adrenal insufficiency

A

all: fatigue, reduced stamina, weakness, anorexia, weight loss, skin hyperpigmentation

some: abdominal pain, MSK pain, psychiatric symptoms, salt cravings, low blood pressure, vomiting

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21
Q

what are the labs in a patient with adrenal insufficiency

wbc:
serum glucose:
serum sodium:
serum postassium:

A

wbc: low- neutropenia
serum glucose: low (low cortisol)
serum sodium: low (low aldosterone)
serum postassium: high(low aldosterone)

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22
Q

in primary adnreal insufficiency also known as _ _ there is _ 8 AM plasma cortisol accompanied simultaneously by signifigant elevation of plasma _

A

addisons disease

low

ACTH

23
Q

what are the symptoms of acute adrenal crisis

A

dehyration, dissiness, rapid heart rate, confusion, fever, headache, abdominal pain

24
Q

what are the lab findings for acute adrenal crisis

cortisol
blood sugar
serum sodium
serum potassium
ph
inadqeuate bump in _ level with a ACTH stimulation test

A

cortisol: low
blood sugar: low
serum sodium: low
serum potassium : high
ph: metabolic acidosis
inadqeuate bump in CORTISOL level with a ACTH stimulation test

25
Q

how do you treat acute adrenal crisis

A

hydrocortisone (critical)
IV/glucose
fludrocortisone after hydrocortisone
treat hyperkalemia

26
Q

lower than normal serum cortisole would typically result in _ serum ACTH if everything was working normally

A

increased/high

27
Q

a lack of pituitary secretion of ACTH in response to a low serum cortisol indicated?

A

that the problem is higher than the adrenal gland itself: pituitary tumor, damage?

28
Q

low serum ACTH in the setting of low serum CORTISOL is consistent with?

A

secondary adrenal insufficiency

29
Q

signs of cushing syndrome

A

increased cortisol
obesity, truncal weight gain
moon face
buffalo hump
hirsutism
thirst.polyuria
hypertension
dark purple striae
mental symptoms
impaired wound healing
suceptibility to opportunisitc infections

30
Q

elevated midnight cortisol levels are indicative of?

A

cushing syndrome

31
Q

what is the best screening test for cushing syndrome

A

dexmathasone stimulation test

32
Q

dexmethasone should suppress _ from the anterior pituitary

A

ACTH

33
Q

explain the dexmethasone test

A
  1. low dose dexmathasone is given at night
  2. serum cortisol levels are drawn in the morning
  3. if serum cortisol is below a certain level then you can exclude cushing syndrome
  4. you compaire cortisol levels with ACTH levels before dexamathasone was given
34
Q

is acth is low, and cortisol is not suppressed by high or low doses what is the disease

A

primary hypercortilism meaning that the problem is in the adrenal gland

35
Q

if ACTH is super elevated and cortisol is not suppresed by high or low doses of dexamethasone then this means

A

there is ectopic acth

36
Q

if ACTH is normal or midly elevated and cortisol is not suppressed by low but is suppresed by low doses what is this outcome

A

cushing disease (pituitary issue)

37
Q

ectopic ACTH syndrome is often associated with?

A

small cell carcinoma of the lung

38
Q

why are most patients with primary aldosteronism are hypertensive

A

excessive aldosterone production increases sodium retention which pulls water with it and increases the blood pressure

39
Q

what are the signs of primary aldosteronism

A

hypertension, hypokalemia (muscle weakness, polyuria.plydipsia)

40
Q

consider the diagnosis of primary aldosteronism if?

A
  1. treatment resistant hypertension
  2. severe hypertension
  3. early onset hypertension
  4. hypertension with adrenal mass
  5. low renin hypertension
  6. hypertension with a family history of early onset HTN or CVA
  7. 1st degree relative with aldosteroinism
41
Q

primary aldosteronism has what 3 things

A

hypokalemia
metabolic alkalosis
low renin hypertension

42
Q

what is conn syndrome

A

it was a unilateral aldosterone producing adrenal adenoma that caused HTN

but not it is just a way to state that someone has primary hyperaldosteronism (from the adrenal gland)- doesnt have to be an adenomatous cause

43
Q

what is the location of a pheochromocytoma and what does it secrete

A

adrenal medulla

secretes catecholamines

44
Q

where is a paraganglioma located and what does ti secrete

A

outside of the adrenal gland

can secrete nothing or secrete catecholamines

45
Q

what are the symptoms of a pheochromocytoma and a paraaganglioma since they present similarily

A

paroxysmal (sudden)
pressure elevated (blood pressure)
pounding pain (headache)
perspiration
panic
palpitations
pallow (after the spell has subsided)

the 7 p’s

46
Q

what is the most sensitive test for diagnosing secretory pheochromocytomas and paraganlgiomas

A

plasma fractionated free metanephrines

47
Q

Von Hippel Linadu- disease type 2 is inherited in a _ (pattern) fashion, 20% of people will develop _ and patients will have _ _ hemangiomas, hemanigioblastomas of the _ and an increased risk for _ _ that transform into renal cell carcinoma

A

autosomal dominant

pheochromocytomas

retinal capullary

CNS

renal cysts

48
Q

how should you treat pheochromocytomas?

A

alpha blockers first then beta blockers

(alpha first because unopposed alpha recetor stimulation can lead to an elevation of blood pressure)

49
Q

adrenal gland incidentalomas are usually found on ?

A

abdominal CTs, MRI, done for other problems

50
Q

most adrenal gland incidentalomas are _ (benign/malignant)

A

benign

51
Q

if an adrenal gland is more that _ cm and is not a benign lesion, cyst or has hemorrhage it should be _

A

4cm

ressected

52
Q

if a patient with an adrenal incidentaloma presents then there is required testing for?

A

cushing syndrome, hyperaldosteroinism, pheochromocytoma testing

53
Q

MEN syndromes are caused by?

A

gene mutations and tend to run in families

ENRP Exam 2 (13 decks)

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