Mixed 21 Flashcards
What is a common iatrogenic cause of Cushing syndrome? How would hormone levels of CRH, ACTH, and cortisol look?
Chronic exogenous glucocorticoids, such as in SLE treatment. Glucocorticoids can suppress the entire HPA axis, and this can cause bilateral adrenal cortical atrophy.
What is a possible complication of suddenly stopping corticosteroid use after chronic usage?
After chronic corticosteroid use, suddenly stopping can precipitate adrenocorticoid insufficiency and adrenal crisis as a result of the prolonged suppression of ACTH and subsequent adrenal atrophy.
What would you give as immediate treatment for adrenal crisis?
Aggressive fluid resuscitation w/ immediate glucocorticoid supplementation (dexamethasone, hydrocortisone). Don’t wait for results of diagnostic studies; response is usually rapid.
How do Thiazide diuretics cause Hypercalcemia?
Thiazides inhibit apical Na/Cl symporter, w/c dec. NaCl absorption, thus inc. intracellular Na in DCT cells. This increases activity of basolateral Na-Ca exchanger, resulting in dec. intracellular Ca that acts to inc. Ca absorption from the lumen, causing hypercalcemia.
What electrolyte disturbances can be found in primary adrenal insufficiency (Addison disease)?
MCC is autoimmune adrenalitis, in w/c the adrenal cortex is attacked – dec. cortisol, dec. aldosterone; inc. ACTH and MSH. The dec. aldosterone causes hyponatremia and hyperkalemia. There is also dec. H+ excretion that causes non-anion gap metabolic acidosis w/ dec. serum HCO3. There is Cl- retention to compensate (hyperchloremia).
How do you diagnose for Celiac disease?
Celiac disease is an autoimmune reaction to gluten. A duodenal biopsy would show villus flattening and intraepithelial lymphocyte infiltration (duodenum and jejenum are exposed to highest concentration of gliadin).
