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Endo Week 1 > Hyperaldosteronism and Pheochromocytoma > Flashcards

Hyperaldosteronism and Pheochromocytoma Flashcards

1
Q

where in adrenal do aldosteronomas arise?

A

in zona glomerulosa

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2
Q

where is issue in primary hyperaldo?

A

in adrenal gland

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3
Q

what are the two main causes of primary hyperaldo?

A

unilateral adenoma
and
bilateral adrenal hyperplasia

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4
Q

what is another name for primary hyperaldo from unilateral adenoma?

A

Conns syndrome

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5
Q

primary hyperaldo leads to what three ion changes

A

Na reabsorption in kidney
K+ excretion
H+ excretion

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6
Q

what three things do you measure in diagnosis for primary hyperaldo

A

serum aldo
plasma renin
aldo:renin ration

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7
Q

primary hyperaldo has what lab values for serum aldo
plasma renin
aldo:renin ratio?

A

Plasma aldo increased
renin decreased
ration increased

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8
Q

secondary hyperaldo has what lab values for serum aldo
plasma renin
aldo:renin ratio?

A

increased aldo
increased renin
normal or low ratio

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9
Q

what are four possible etiologies of secondary hyperaldo?

A

renin producing tumor
coarctation of the aorta
fibromuscular dysplasia
renal artery stenosis

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10
Q

if you have what seems to be high aldo but low aldo conc and low renin, what are possible causes? what is this called?

A

called pseudohyperaldo

Congen adrenal hyperplasia, cushings, licorice are possible causes

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11
Q

what is confirmation test for primary hyperaldo?

A

aldosterone suppression test by giving a salt load

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12
Q

what should response be to a salt load? what happens in primary hyperalso?

A

decreased aldosterone…primary hyperaldo does not decrease the aldo in response to increased salt load

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13
Q

what is rx for young patient with clear unilateral adrenal mass secreting aldo?

A

surgery…unilateral adrenalectomy

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14
Q

what test can you do to help determine where aldo is coming from in adrenals? like which one or both producing?

A

adrenal vein sampling

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15
Q

if adrenal vein sampling for aldo lateralizes what does this mean?

A

that aldo increase is mainly from lateralized side and likely a unilateral problem so surgery more likely to help

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16
Q

if adrenal vein sampling does not lateralize what does that mean?

A

patient likely has bilateral adrenal hyperplasia and aldo coming from both sides

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17
Q

which adrenal vein is easier to sample from? why?

A

left suprarenal vein because angle is less severe, right is at 90 degree angle

18
Q

what is rx for aldo producing adenoma?

A

surgery

19
Q

what is rx for bilateral hyperplasia?

A

medication

20
Q

name the two drugs to treat aldo excess

A

spiranolactone and epleronone

21
Q

which of spiranolactone and epleronone is used more, why?

A

spironolactone…bc cheaper

22
Q

secondary hyperaldo in adults is most commonly due to what?

A

renal artery stenosis

23
Q

what is rx for renal artery stenosis?

A

balloon angioplasty or ACE/ARBs

24
Q

what is MEN1?

A

a genetic neuroendocrine causing tumor

25
Q

what three tumors arise from MEN1 mutations?

A

primary hyperparathyroid
pituitary adenomas
pancreatic neuroendocrine tumor

26
Q

what is inheritance of MEN1

A

AD

27
Q

in addition to parathyroid, pancreas and pituitary, what other endo organ can have issue in MEN1?

A

adrenal adenomas

28
Q

what happens in MEN 2 type 2A?

A

medullary thyroid cancer with primary hyperparathyroid

pheochromocytoma

29
Q

what is inheritance of MEN2 type 2A?

A

AD

30
Q

what happens in MEN2 type 2B?

A

medullary thyroid cancer, pheochromocytoma

31
Q

what is inheritance of MEN2 type 2b?

A

AD

32
Q

what is pheochromocytoma a tumor of?

A

chromaffin cells in adrenal medulla

33
Q

why are pheochromocytomas called the 10% tumor?

A

10% bilateral
10% outside the adrenal medulla in symp ganglia
10% malignant
30% inherited

34
Q

what are the three main symptoms of pheochromocytoma?

A

HA
diaphoresis
palpitations

35
Q

what are two things to measure when worried about pheochromocytoma?

A

24 hr urine metaneprines and plasma metanephrines

36
Q

are pheochromocytomas always only in adrenal medulla?

A

no can have tumor in sympathetic ganglia too. called paraganglionoma

37
Q

if worried about paraganglionoma what should you do?

A

CT/MRI of abdomen called 123 I_MIBG

38
Q

what is fist rx for pheochromocytoma?

A

surgery

39
Q

describe medical management of pheochromocytoma

A

alpha block first then beta block with vigorous hydration

40
Q

why do you alpha block before you beta block in pheochromocytoma?

A

beta adrenergic normal effect on vasculature is to vasodilate so if you block it first then alpha is unopposed in constriction and can have worsening HTN

Endo Week 1 (10 decks)

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