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la endo Flashcards

cortisol,

1
Q

In response to low serum cortisol or stress…

A

the hypothalamus secretes corticotropin releasing factor (CRF)

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2
Q

In response to CRF…

A

the pituitary releases adrenocorticotropic hormone (ACTH) and melanocyte releasing hormone

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3
Q

In response to ACTH …

A

the adrenal glands secrete cortisol

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4
Q

In response to elevated cortisol levels…

A

the hypothalamus decreases production of CRF

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5
Q

Cortisol is produced by the ___ in a reaction to ___. Its main functions are to suppress ___ and increase available ___ by increasing ___ levels and promoting the breakdown of __ and ___. It also regulates ___

A

Cortisol is produced by the adrenal glands in a reaction to stress. Its main functions are to suppress the immune response and increase available energy by increasing** blood sugar** levels and promoting the breakdown of fat and protein. It also regulates electrolytes.

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6
Q

Cushing’s syndrome = ____ cortisol production

Addison’s disease = ___ cortisol production

A

Cushing’s syndrome = excessive cortisol production

Addison’s disease = low cortisol production

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7
Q

Cushing’s disease
Pituitary …
gender

A

Cushing’s disease

  • Pituitary adenoma with hypersecretion of ACTH stimulating cortisol production in the adrenals.
  • Women have a three times greater chance of having this than men.
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8
Q

Cushing’s syndrome

3 causes

A
  • Adrenal tumor producing an increase in cortisol
  • Ectopic production of ACTH – most commonly a small cell lung cancer
  • Long term use of corticosteroids usually in treatment of another disease
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9
Q

cushing’s disease vs syndrome

A

syndrome is caused by an outside source (outside)

disease is caused by an inside source (pituitary)

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10
Q

most specific signs of cushings

A

moon facies, (acanthosis nigrans) pigmented striae more than 1 cm wide(thigh, breast, abdomen), buffalo hump, truncal obesity, hirsutism

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11
Q

moon facies, (acanthosis nigrans) pigmented striae more than 1 cm wide(thigh, breast, abdomen), buffalo hump, truncal obesity, hirsutism

A

cushings syndrome

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12
Q

cushings skin symptoms

A

poor wound healing
atrophy
acanthosis nigrans
thin extremities

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13
Q

cushings disease

-glucose, K++, cortisol

A

hyperglycemia
Hypokalemia
Cortisol is elevated

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14
Q

hyperglycemia
Hypokalemia
Cortisol is elevated

A

cushings disease

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15
Q

ACTH (cushings)
elevated
low

A

ACTH
elevated – pituitary or ectopic adenoma
low – adrenal cortex problem

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16
Q

cushings disease
MRI or
CT

A

MRI for pituitary tumor

CT for adrenalcortical or other tumors

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17
Q

For Cushing’s disease (pituitary adenoma) tx

A

transsphenoidal resection

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18
Q

1-metyrapone and ketoconazole
2-Parenteral octreotide

A

Cushings
– may suppress hypercortisolism.
-may suppress ACTH

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19
Q

what may suppress ACTH

A

Parenteral octreotide

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20
Q

Often patients treated for Cushing’s syndrome will go into ___ withdrawal, …

A

cortisol withdrawal, Addison’s disease, and require hydrocortisone or prednisone.

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21
Q

adrenal cortex releases what 3 things

A

androgen/sex hormones, aldosterone, cortisol

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22
Q

aldosterone 3 functions

A
  • regulates BP
  • retains Na
  • secretes K+
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23
Q

cortisol functions (3)

A
  • increase blood glucose
  • breaks down fats/proteins/carbs
  • regulates electrolytes
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24
Q

prognosis of cushings after succesful excision of a benign adrenal adenoma

A

95% chance of a 5 year survival

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25
Q

% of recurrence over 10 years with cushings

A

15-20%

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26
Q

what % of addison’s is secondary to autoimmune issues

- other 4 causes

A

80% Other causes include TB, genetic disorders, removal of adrenals, trauma(hemorrhaging)

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27
Q

addison’s secondary causes are …

A

pituitary based

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28
Q

calicification of adrenal glands

A

TB

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29
Q

precipated by infection, trauma, surgery, stress, SUDDEN cessation of corticosteroid medications

A

adrenal crisis

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30
Q

nonspecific GI symptoms, hypoglycemia, weakness, myalgias, fatigue, lethargy, salt craving, mild hyponatremia

A

secondary adrenocortical insufficiency

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31
Q

Sparse axillary and pubic hair
Hyperpigmentation of skin especially of creases or pressure areas (waistband/bra line)
Hypotension typically systolic under 110
Salt craving
AMENORRHEA

A

addison’s

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32
Q

addison’s symptoms

A

Sparse axillary and pubic hair
Hyperpigmentation of skin especially of creases or pressure areas (waistband/bra line)
Hypotension typically systolic under 110 mmhg
AMENORRHEA
Salt craving

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33
Q

addison’s

  • menstuation
  • hair
  • reflexes
  • BP
A
  • amenorrhea
  • sparse axillary and pubic hair
  • delayed DTR
  • low BP
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34
Q

hyperpigmentation in addison’s

A

only in primary disease when ACTH is elevated

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35
Q

hypotension, acute abd or low back pain, vomiting, diarrhea, dehydration, altered mental status

A

addisonian crisis; can be fatal if untreated

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36
Q

Cosyntropin stimulation test or ACTH stimulation test

A

cosyntropin test is diagnostic; ACTH is injected and the plasma cortisol is then monitored for a reaction.
- a serum cortisol rise of more than 18 after adminstration of cosyntropin is nml; anything less is suspicious

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37
Q

imaging of addison’s

A

Chest x-ray for TB

Abdominal CT – small adrenal glands in an autoimmune disease

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38
Q

diagnostic (addison’s)

- early plasma cortisol and ACTH

A

low cortisol(under 3) and elevated ACTH(over 200)

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39
Q

DHEA level of 1,000

-produced where

A
  • anything higher excludes Addison’s

- adrenal gland

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40
Q

addison’s tx

A
  • Replacement with oral hydrocortisone 1st line. Dexmethasone.
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41
Q

Fludrocortisone

A

Has sodium retaining properties and is the treatment for Addison’s.

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42
Q

addison’s length of steroids

A

These are given for life and should be monitored by clinical symptoms as well as blood tests to assure proper dosing throughout the patient’s lifespan

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43
Q

addison’s tx for improved well being, increased muscle mass, reversal of femoral neck bone loss

A

DHEA; monitor for androgenic effects

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44
Q

addisonian crisis tx

A

IV saline, glucose, glucocorticoids and tx of underlying disease

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45
Q

high fever
low blood pressure
confusion or coma
hypoglycemia

A

adrenal crisis

give IV saline, glucose, glucocorticoids

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46
Q

primary and secondary addison’s differences

A

primary: assoc with increased skin pigmentation, decreased glucocorticoids and decreased mineralcorticoids

secondary: ONLY assoc with decreased glucocorticoids and DOES NOT have skin pigmentation or hyperkalemia

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47
Q
A
  1. cortisol
  2. aldosterone
  3. DHEA
  4. ACTH
48
Q

Most common etio for Addisons

A

autoimmune, think Hashimotos or DM type 1

49
Q

autoimmune, Hashimotos or DM type 1

A

think Addisons

50
Q

sudden d/c of exogenous steroid

A

secondary adrenal insufficiency

and/or Addisonian crisis

51
Q

“Stress Hormone”

A

cortisol

52
Q

in treating a pt with chronic adrenal insufficiency, they must be given IV glucocorticoids and _______ before and after surgical procedures

A

IV isotonic fluids

53
Q
A

inc ACTH: Cushing disease;
dec ACTH; Cushing disease

54
Q
A

acanthosis nigricans: Cushing’s

55
Q
A

chronic renal insuff

56
Q
A

cushing

57
Q

tx for cushing disease

A

transspenoidal resection

58
Q

24 hr urinary free cortisol,
nighttime salivary cortisol,
low dose overnight dexmathasone suppression test

most specific?

A

24 test.

order 2 of these tests for cushings disease

59
Q

hyperglycemia, leukocytosis, hypokalemia, metabolic alkalosis

A

Cushings disease

60
Q

hyponatremia, hyperkalemia, hypoglycemia

A

Chr. adrenal insufficieny

61
Q
A

hyponatremia is SIADH

62
Q

chronic hyponatremia tx

1) rate
2) unresponsive to fluid restriction
3) euvolemic or hypervolemic hyponatremia

A

1) over 72 hr duration with <8 mEq/L/day
2) demeclocycline
3) vasopressin antagonists(conivaptan)

63
Q
A

SIADH

64
Q
A

DI on left
SIADH on right

65
Q

chronic hyponatremia tx

1) rate
2) unresponsive to fluid restriction
3) euvolemic or hypervolemic hyponatremia

A

1) over 72 hr duration with <8 mEq/L/day
2) demeclocycline
3) vasopressin antagonists(conivaptan)

66
Q

labs in volume depletion

A

hemocrit and serum albumin increased

urinary sodium decreases

urea increases (secondary to urine stasis in nephron) but little change in serum Cr

67
Q
A

primary hyperaldosteronism

68
Q

Most common cause of primary hyperaldosteronism

A

adrenal hyperplasia: hyperfunctioning adrenal releasing lots of aldosterone

69
Q

describe secondary hyperaldosteronism

A

increase RAAS activity, increase renin and this leads to increase in aldosterone

70
Q

HTN, HYPOkalemia, metabolic alkalosis

A

triad of hyperaldosteronism

71
Q

Primary _____ is a cause of secondary HTN

A

hyperaldosteronism

72
Q

polyuria, fatigue, prox muscle weakness, decreased DTR, hypomagnesemia, constipation

A

hypokalemia

73
Q

pt develops HTN at extreme age, not controlled on 3 meds

A

primary hyperaldosteronism

74
Q

what test to dx hyperaldosteronism

A

renin and aldosterone levels.

both high: secondary

aldosterone high and renin low: primary. maybe do a adrenal supp test

75
Q
A

hypo on left. hyper on right

do labs later.

76
Q
A

hyperthyroidism

77
Q

hyperthyroidism definitive tx

A

radioactive thyroid ablation or total thyroidectomy

- give levothyroxine (oral T4) and steroids

78
Q
A

avoid aspirin!

Iv fluids, propanolol, PPU and IV glucocorticoids.

79
Q

increased aldosterone and decreased renin

A

primary hyperaldosteronism

80
Q

MC etio of primary hyperaldosteronism

A

bilateral adrenal hyperplasia

81
Q

increased aldosterone and renin

A

secondary hyperaldosteronism

82
Q

Conn syndrome

A

aldosteronoma

83
Q

findings with hyperaldosteronism

A

secondary HTN
hypernatremia
hypokalemia
metabolic alkalosis

84
Q

secondary HTN
hypernatremia
hypokalemia
metabolic alkalosis

A

hyperaldosteronism

85
Q

aldosterone function?

A

excretes K+ and H+, holds onto Na; interacts with angiotensin 11

86
Q

testing for hyperaldosteronism

A

get both renin and aldosterone levels

nml ratio: secondary cause (pituitary)

If aldosterone high and renin low: primary (renal cortex)

87
Q

aldosterone is part of which zona layer

A

glomerulosa (outer layer)

88
Q

cortisol is part of which zona layer

A

fasciculata (middle layer)

89
Q

cortisol functions

A

increases blood glucose, osteoclasts, increases BP, helps fight infections

90
Q

decrease in ADH does what to fluid

what about increase

A

decrease causes excretion of fluid, diluted urine, and more water excreted (polyuria)

increase causes more retention of fluid, diluted blood, and more water retained.

91
Q

zona reticularis is which layer and secretes what

A

inner layer, DHEA/androgens

92
Q
A

secondary hyperaldosterone

93
Q
A

hypothyroidism

94
Q
A

hashimotos d/s

95
Q

most common thyroid cancer

2nd

A

papillary

follicular

96
Q

thyroid cancer for age > 65

A

anaplastic

97
Q

thyroid cancer slow growing. distant mets more common than local.

A

follicular

98
Q

thyroid cancer. 90% sporatic. local cervical mets early. distant mets later

A

medullary.

papillary is local mets(cervical(

99
Q

thyroid cancer increased calcitonin

10% associated with MEN

A

medullary

100
Q

thyroid cancer r/f iodine deficiency

A

follicular

101
Q

thyroid cancer

painless

rock hard mass

A

papillary painless

anaplastic hard

102
Q

thyroid cancer. hx of radiation of neck/head. FH

A

papillary

103
Q

thyroid cancer. TSH and T3 and T4 nml. Do FNA

A

papillary

104
Q

thyroid cancer. hematologic spread; lung, liver, brain, bone

A

follicular

105
Q

most sensitive thyroid nodule dx test

A

ultrasound

106
Q

test for thyroid nodule > 1.5 cm with nml TSH

A

FNA

107
Q

if FNA indeterminate for thyroid nodule

A

radioactive iodine uptake

108
Q
A

hyperparathyroidism

109
Q
A
110
Q
A

hyperparathyroidism

111
Q
A

hypoparathyroidism

112
Q
A

vitamin d defiency

113
Q
A

hypo left
hyper right

114
Q
A

dawn left
somogi right

115
Q
A

dawn left
somogi right

endocrine (9 decks)

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