Newman DSA Chapter 26 CMDT Flashcards
What is Addison Disease?
-Primary adrenal insufficiency
EOD for primary adrenal insufficiency
- weakness, fatigue, anorexia, weight loss; nausea, vomiting, diarrhea; abdominal pain, muscle and joint pains; amenorrhea
- Sparse axillary hair, inceased skin pigmentation, especially of creasees, pressure areas, and nipples
- hypotension, small heart
- Low serum Na+, elevated K+, Ca2+, and BUN, mild anemia, relative neutropenia, lymphocytosis, and eosinophilia
- Plasma ACTH level elevated, unable to stimulate an increase in serum cortisol
- Acute adrenal crisis: above manifstations become critical, along with fever shock, confusion, coma, death
What is Cushing Syndrome
Hypercortisolism
EOD for Cushing Syndrome
- central obesity, muscle wasting, thin skin, hirsutism, purple striae
- psychological changes
- Osteoporosis, htn, poor wound healing
- Hyperglycemia, glycosuria, leukocytosis, lymphocytopenia, hypokalemia
- Elevated serum cortisol and urinary free cortisol… Lack of normal suppression by dexamethasone
EOD for Primary Aldosteronism
- htn that may be severe or drug-resistant
- Hypokalemia (in minority of patients) may cause polyuria, polydipsia, muscle weakness
- low plasma renin; elevated plasma and urine aldosterone levels
Why is there hyperpigmentation in adrenal insufficiency (addison disease) patients?
-increased pituitary secretion of alpha-MSH
What is Acute adrenal crisis?
- nausea, vomiting, fever, dehydration, and profound hypotension
- progresses to life-threatening shock that does not fully respond to IV fluids and vasopressors
What is the thing that we could easily confuse cushing sydndrome with?
Adrenocortical carcinoma
-these are usually bigger though… and mets are there
What is the most common cause of refractory htn in youths and middle-aged adults?
Primary aldosteronism
`What does refractory htn even mean?
-htn that still remains there after the use of 3 antihypertensive medications from 3 different classes
What could happen if we give someone who has primary aldosteronism a diuretic?
potassium
What testing would we do for Addison disease (aka: primary adrenal insufficiency)
-WBC: neutropenia, lymphocytosis, eosinophilia
-electrolytes: low Na+, high K+
-fasting hypoglycemia
-plasma cortisol: less than 3 at 8AM is diagnostic
-Serum DHEA: less than 1000
-Anti-adrenal antibodies… 50%
-look for 17-OH progesterone (21 deficiency)
-serum epinephrine: low
-
What test is used to confirm addison disease?
- give dose of synthetic ACTH IM
- measure cortisol 45 minutes after
- if cortisol didn’t get to 20, then it’s confirmed
What testing would we do for cushing’s syndrome?
- Dexamethasone suppression test
- if we give it and the cortisol at 8 AM the next morning is less than 5, then no cushing!
- A 24 hour urinary free cortisol and creatinine (confirmatory test)
- Midnight serum cortisol levels: >7.5
What drugs accelerate the metabolism of dexamethasone?
- rifampin
- antiseizure drugs
