Parathyroid and Adrenal Disorders Flashcards
Question 1 of 9
Mary presents in your office with the unusual complaint of being “more tan” than expected based on her self-report sun exposure. Follow up questions reveal that Mary has been experiencing severe fatigue, dizziness upon standing, and an overall feeling that “something is wrong.” You examine Mary and order blood tests.
The test results show the following abnormalities: low cortisol, low aldosterone, elevated ACTH, low blood glucose, low serum sodium, elevated serum potassium, normal calcium, normal PTH. Mary takes no medications. Which of the following conditions is most likely based on Mary’s laboratory results? Primary hyperparathyroidism Adrenal excess Secondary hyperparathyroidism Adrenal insufficiency
Adrenal insufficiency
Mary’s laboratory results indicate normal PTH and calcium levels, so issues with the parathyroid gland can be ruled out. Low cortisol and elevated ACTH levels are associated with adrenal insufficiency. Elevated cortisol is a sign of adrenal excess.
Question 2 of 9
Based on Mary’s laboratory results, which form of adrenal insufficiency does Mary have? Primary adrenal insufficiency Secondary adrenal insufficiency Tertiary adrenal insufficiency Pheochromocytoma
Primary adrenal insufficiency
Mary’s condition is a result of a problem in the adrenal glands not being able to produce cortisol. The adrenal glands are receiving a signal from the anterior pituitary, shown by the elevated ACTH; however, the glands are incapable of responding to this signal. A tertiary condition is a problem in the hypothalamus, and Mary’s problem is located within the adrenal glands. A pheochromocytoma is a disorder of the adrenal medulla that would present with elevated epinephrine and norepinephrine levels.
Question 3 of 9
What is another name for Mary’s condition? Addison’s disease Cushing’s disease Cushing’s syndrome Pheochromocytoma
Addison’s disease
Addison’s disease is a form of primary adrenal insufficiency. Remember, in Addison’s disease, more adrenal hormones need to be “added.” Cushing’s disease and Cushing’s syndrome are adrenal excess diseases. Pheochromocytoma is a tumor of the adrenal medulla that can lead to hypertensive crisis.
Question 4 of 9
Mary reports that she takes no medications. Which medications may cause adrenal insufficiency? NSAID’s Corticosteroids Anti-histamines Diuretics
Corticosteroids
Corticosteroid usage, especially for longer periods, can suppress normal cortisol production by the adrenal glands. In this case, ACTH levels are also reduced due to the negative feedback by the corticosteroids. The other medications listed do not affect adrenal gland synthesis of cortisol.
Question 5 of 9
What explains Mary’s “tan” appearance?
Reduced blood glucose activates melanocytes
Increased ACTH leads to increased melanocyte-stimulating hormone (MSH)
Cortisol damages melanocytes
Cancer of the melanocytes
Increased ACTH leads to increased melanocyte-stimulating hormone (MSH)
In Mary’s case, reduced cortisol causes an elevation in ACTH. As precursor molecule for ACTH also contains melanocyte-stimulating hormone (MSH). As more ACTH is formed, so is more MSH, which in turn activates melanocytes leading to a tanned appearance.
Question 6 of 9
Which of the following may also result in a "tanned" appearance? Primary adrenal excess Secondary adrenal excess Hypothyroidism Hyperparathyroidism
Secondary adrenal excess
Secondary adrenal excess refers to a problem in the anterior pituitary, the organ that synthesizes ACTH. In secondary adrenal excess, ACTH is elevated, along with its precursor molecule, which contains melanocyte-stimulating hormone.
Question 7 of 9
Which of the following most likely causes Mary’s low blood glucose? Reduced aldosterone Elevated ACTH Low serum sodium Low cortisol
Low cortisol
Cortisol is a glucose-sparing hormone, meaning it works to keep blood glucose levels elevated. With inadequate cortisol, blood glucose levels may fall. Neither aldosterone nor ACTH directly affect blood glucose levels.
Question 8 of 9
What factor is likely playing a role in Mary’s abnormal serum sodium and potassium levels? Elevated ACTH Reduced cortisol Reduced aldosterone Normal PTH
Reduced aldosterone
Aldosterone is released from the adrenal cortex and targets the kidneys. Aldosterone stimulates sodium reabsorption and potassium secretion by the kidneys. Without adequate aldosterone, sodium is excreted in the urine, while potassium is reabsorbed.
Question 9 of 9
Which of the following conditions do you also suspect Mary may experience? Weight gain Hypotension Diabetes mellitus Insulin resistance
Hypotension
Both aldosterone and cortisol, which are low in Mary, help maintain blood pressure. Without adequate levels of these hormones, a patient may experience hypotension. Aldosterone stimulates sodium and water reabsorption, maintaining blood volume and blood pressure. Cortisol is a vasoconstrictor, which also helps maintain blood pressure.
Question 1 of 5
Primary hyperparathyroidism is most commonly caused by ______________.
a tumor of the anterior pituitary
a tumor of the parathyroid glands
excess adrenocorticotropic hormone secretion
elevated serum calcium levels
a tumor of the parathyroid glands
Question 2 of 5
Destruction or removal of the parathyroid glands will cause _________________.
secondary hypoparathyroidism
primary hyperparathyroidism
primary hypoparathyroidism
pheochromocytoma
primary hypoparathyroidism
Question 3 of 5
In Cushing’s syndrome, a ____________ adrenal gland causes elevated levels of _____________.
hypoactive; cortisol
hyperactive; adrenocorticotropic hormone
hypoactive; adrenocorticotropic hormone
hyperactive; cortisol
hyperactive; cortisol
Question 4 of 5
Which of the following would you expect to see in a patient suffering from Addison’s disease?
Elevated cortisol
Hypoglycemia
Elevated norepinephrine
Elevated serum calcium
Hypoglycemia
Question 5 of 5
To determine if a patient is suffering from pheochromocytoma, which laboratory value would you examine?
Aldosterone
Norepinephrine
Cortisol
Adrenocorticotropic hormone
Norepinephrine
