HYHO - Newman #2

Question 1

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

Answer 1

stress

digestion, immune system, mood, sexuality, energy

Question 2

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

Answer 2

negative feedback system

Question 3

what zone of the adrenal cortex is responsible for

mineralocorticoids
glucorticoids
sex steroids

Answer 3

mineralocorticoids- glomerulosa
glucorticoids- fasiculata
sex steroids- reticularis

Question 4

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

Answer 4

adrenal medulla

via preganglionic sympathetic ribers

catecholamines

Question 5

example of short term stress reponses

Answer 5

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

Question 6

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

Answer 6

CRH stimulation from the anterior pituitary

stumulation of the adnreal cortex by ACTH

and release of mineralocorticoids and glucocorticoids

Question 7

what are mineralocorticoids? what do they do?

Answer 7

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

increased blood volume and blood pressure

Question 8

what are the glucocorticoids? what do they do?

Answer 8

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

Question 9

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

Answer 9

renal, cardiac, vascular

Question 10

renin secretion from the kidney is stimulated by?

Answer 10

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

Question 11

angiotensiongen is converted to angiotensin I by _

angiotensin I is converted to angiotension II by _

angiotensin II stimulates _ release from the _

Answer 11

renin

angiotension converting enzyme

aldosterone

from the adrenal cortex

Question 12

always _ the genitalial of a newborn baby

Answer 12

examine

Question 13

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

Answer 13

congenital adrenal hyperplasia causing virilization of the genitalia

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

Question 14

what is the common def. in congeital adrenal hyperplasia

what is there an increase of

Answer 14

21-hydroylase def (increased testosterone)

increase of the precursor - 17-OH progesterone

Question 15

symptoms of congeital adrenal hyperplasia in a neonate

Answer 15

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

Question 16

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

Answer 16

cause: 21 hydroxylase def

aldosterone: low
cortisol: low
androgens: high

Question 17

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

Answer 17

hydrocortisone IV or IM (lifesaving)

fluids/glucose

management of hyperkalemia

Question 18

what is the purpose of mandatory newboen screening

Answer 18

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

Question 19

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

Answer 19

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

Question 20

primary symptoms of primary adrenal insufficiency

Answer 20

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

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

Question 21

what are the labs in a patient with adrenal insufficiency

wbc:
serum glucose:
serum sodium:
serum postassium:

Answer 21

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

Question 22

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

Answer 22

addisons disease

low

ACTH

Question 23

what are the symptoms of acute adrenal crisis

Answer 23

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

Question 24

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

Answer 24

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

Question 25

how do you treat acute adrenal crisis

Answer 25

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

Question 26

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

Answer 26

increased/high

Question 27

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

Answer 27

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

Question 28

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

Answer 28

secondary adrenal insufficiency

Question 29

signs of cushing syndrome

Answer 29

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

Question 30

elevated midnight cortisol levels are indicative of?

Answer 30

cushing syndrome

Question 31

what is the best screening test for cushing syndrome

Answer 31

dexmathasone stimulation test

Question 32

dexmethasone should suppress _ from the anterior pituitary

Answer 32

ACTH

Question 33

explain the dexmethasone test

Answer 33

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

Question 34

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

Answer 34

primary hypercortilism meaning that the problem is in the adrenal gland

Question 35

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

Answer 35

there is ectopic acth

Question 36

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

Answer 36

cushing disease (pituitary issue)

Question 37

ectopic ACTH syndrome is often associated with?

Answer 37

small cell carcinoma of the lung

Question 38

why are most patients with primary aldosteronism are hypertensive

Answer 38

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

Question 39

what are the signs of primary aldosteronism

Answer 39

hypertension, hypokalemia (muscle weakness, polyuria.plydipsia)

Question 40

consider the diagnosis of primary aldosteronism if?

Answer 40

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

Question 41

primary aldosteronism has what 3 things

Answer 41

hypokalemia metabolic alkalosis low renin hypertension

Question 42

what is conn syndrome

Answer 42

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

Question 43

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

Answer 43

adrenal medulla secretes catecholamines

Question 44

where is a paraganglioma located and what does ti secrete

Answer 44

outside of the adrenal gland can secrete nothing or secrete catecholamines

Question 45

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

Answer 45

paroxysmal (sudden) pressure elevated (blood pressure) pounding pain (headache) perspiration panic palpitations pallow (after the spell has subsided) ## Footnote the 7 p's

Question 46

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

Answer 46

plasma fractionated free metanephrines

Question 47

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

Answer 47

autosomal dominant pheochromocytomas retinal capullary CNS renal cysts

Question 48

how should you treat pheochromocytomas?

Answer 48

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

Question 49

adrenal gland incidentalomas are usually found on ?

Answer 49

abdominal CTs, MRI, done for other problems

Question 50

most adrenal gland incidentalomas are _ (benign/malignant)

Answer 50

benign

Question 51

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

Answer 51

4cm ressected

Question 52

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

Answer 52

cushing syndrome, hyperaldosteroinism, pheochromocytoma testing

Question 53

MEN syndromes are caused by?

Answer 53

gene mutations and tend to run in families