OnlineMedEd: Endocrine - "Adrenals" Flashcards

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1
Q

List the two sites that ACTH-producing tumors can arise.

A
  • Lung (SCC)

* Pituitary

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2
Q

Describe the presentation of Cushing’s.

A

Cushing’s causes things that are common in other diseases and things that are specific to Cushing’s.

Common:

  • HTN
  • DM
  • Obesity

Specific:

  • Striae
  • Acne
  • Buffalo hump
  • Moon facies
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3
Q

Review the diagnostic workup of Cushing’s syndrome.

A

Remember, LOW THEN HIGH:
•First, LOW-dose dexamethasone-suppression test (see if dexamethasone suppresses the cortisol.
• Second, THEN test the ACTH. If it is low, then you know it is a primary adrenal tumor.
•Third, if ACTH is high, then do a HIGH-dose dexamethasone-suppression test (to see if dex suppresses ACTH, which it will in Cushing’s disease but not SCC).

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4
Q

In conjunction with the low-dose dexamethasone suppression test, you should do a _____________.

A

cortisol test (either midnight salivary cortisol or 24-hour urinary cortisol)

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5
Q

The three most common causes of adrenal insufficiency are ____________.

A

Addison’s (autoimmune destruction), iatrogenic (too much steroids), and TB

Anterior pituitary causes are also possible though less common.

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6
Q

Describe the acute and chronic presentations of adrenal insufficiency.

A

Acute:

  • Hypotension
  • N/V
  • Coma

Chronic:

  • Hyperpigmentation
  • Hyponatremia
  • Hyperkalemia
  • Orthostatic
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7
Q

Explain the diagnostic workup of suspected Addison’s.

A
  • First, test AM cortisol levels. If they are low, proceed.
  • Second, do a cosyntropin-stimulation test. If the cortisol does not rise, then it is likely primary adrenal insufficiency.
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8
Q

What do you do with the cosyntropin stim results?

A
  • If cortisol rises, then it is secondary adrenal insufficiency (i.e., broken pituitary) and you just need to replace cortisol.
  • If cortisol does not rise, then it is likely primary adrenal insufficiency and you need to give cortisol and mineralocorticoids.
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9
Q

_____________ is typical of hyperaldosterone states.

A vital sign and a BMP finding

A

HTN and hypokalemia

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10
Q

Review the five Ps of pheochromocytoma.

A
Paroxysms of 
Palpitations, 
Pain in the head, 
Perspiration, and 
elevated blood Pressure.
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11
Q

What size cutoff necessitates adrenal incidentaloma resection?

A

4 cm

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