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ENRP - Exam 2 > Pediatric Adrenal > Flashcards

Pediatric Adrenal Flashcards

1
Q

What does the HPA axis control reactions to?

A

Stress

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2
Q

What is the HPA axis?

A

CRH
ACTH
Cortisol
– Cortisol provides (-) feedback to pituitary and hypothalamus

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3
Q

Why is (-) feedback important?

A

Regulates hormone concentration in the blood

– not too much or too little

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4
Q

With the Short-Term Stress Response, what is activated and how?

A

Adrenal medulla via preganglionic sympathetic fibers

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5
Q

With the Short-Term Stress Response, what is released?

A

Catecholamines

- Sympathetics (+) Adrenal Medulla

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6
Q

If a patient presents with an elevated HR, RR, glucose, metabolic rate and bronchiol dilation… what type of stress response is occurring?

A

Short-Term Stress Response

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7
Q

With the Long-Term Stress Response, describe the cascade

A
  • CRH (+) anterior pituitary

- ACTH (+) Adrenal cortex

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8
Q

With the Long-Term Stress Response, what is released?

A

Mineralcorticoids (aldosterone)

Glucocorticoids (cortisol)

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9
Q

With the Long-Term Stress Response, what does the Aldosterone and Cortisol do?

A 
Aldosterone = Na+/H2O retention to increased BP
Cortisol = Increased blood glucose and immune suppression
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10
Q

If there is decreased renal perfusion or sympathetic activity, what does the kidney do?

A

Secretes Renin => Aldosterone release through RAAS system

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11
Q

What is the most common cause of Newborn Ambiguous Genitalia?

A

Congenital Adrenal Hyperplasia

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12
Q

What is the most common cause of Newborn Ambiguous Genitalia?

A

Congenital Adrenal Hyperplasia

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13
Q

What is usually deficient with Congenital Adrenal Hyperplasia?

A

21-Hydroxylase

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14
Q

What occurs with Congenital Adrenal Hyperplasia if there is deficient 21-Hydroxylase?

A
  • Decreased Aldosterone, Cortisol

- ELEVATED 17-hydroxyprogesterone and ANDROGENS

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15
Q

Besides ambiguous genitalia, what are some signs of Congenital Adrenal Hyperplasia?

A

Failure to thrive
Vomiting, Dehydration and Shock
Hyponatremia and Hyperkalemia = Hypotension

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16
Q

What is the treatment for Congenital Adrenal Hyperplasia?

A

Hydrocortisone + Fluids/glucose + Management of Hyperkalemia

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17
Q

With the treatment of Congenital Adrenal Hyperplasia, what is the most essential life saving step?

A

Hydrocortisone - IV/IM

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18
Q

What are 3 common causes of Primary Adrenal Insufficiency?

A
  • Adrenal dysfunction/destruction (autoimmune)
  • Adrenal dysgenesis (x-linked adrenal HYPOplasia)
  • Impaired Steroidogenesis (adrenal HYPERplasia)
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19
Q

What are the common symptoms of Primary Adrenal Insuffiiciency?

A

Fatigue
Weakness
Weight loss
Skin Hyperpigmentation

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20
Q

What are 4 lab changes with Primary Adrenal Insufficiency?

A
  • Neutropenia
  • LOW Na+
  • HIGH K+
  • Fasting hypoglycemia
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21
Q

With Primary Adrenal Insufficiency, the 8 am Cortisol is ____ and accompanied by a ____ ACTH

A

LOW morning Cortisol

HIGH morning ACTH

22
Q

Primary Adrenal Insufficiency levels of Cortisol and ACTH

A

LOW cortisol

HIGH ACTH

23
Q

Secondary Adrenal Insufficiency levels of Cortisol and ACTH?

A

LOW cortisol

LOW ACTH

24
Q

Adrenal Crisis presents similarly to sepsis. What are the levels of cortisol, blood sugar, sodium?

A

LOW

25
Q

Adrenal Crisis presents similarly to sepsis. There will be metabolic _____

A

Acidosis

26
Q

What is the treatment for Adrenal Crisis?

A

Hydrocortisone + Fluids/glucose + Fludrocortisone + management of hyperkalemia if necessary

27
Q

What lab is indicitave of Cushing Syndrome?

A

Elevated midnight cortisol levels

28
Q

Elevated midnight cortisol level

A

Cushing Syndrome

29
Q

What test should normally suppress ACTH?

A

Dexamethasone

30
Q

If the serum cortisol is suppressed with Dexamethasone, is it Cushing Syndrome?

A

NO

31
Q

Primary Hypercortisolism, there will be low ACTH. Will there be cortisol suppression with the dexamethasone suppression test?

A

NO

32
Q

When will there be Cortisol suppression when you perform the dexamethasone suppression test?

A

Cushing Disease only

33
Q

Another name for Primary Aldosteronism?

A

Conn Syndrome

34
Q

Can an Adrenal Adenoma producing primary aldosteronism be present with Conn Syndrome?

A

Can or cannot – doesn’t matter either way

35
Q

What are some symptoms of Primary Aldosteronism?

A

HTN

Hypokalemia = muscle weakness, polyuria, polydipsia, paresthesias

36
Q

Triad with Primary Aldosteronism?

A

LOW renin HTN
Hypokalemia
Metabolic Alkalosis

37
Q

Triad with Primary Aldosteronism

A

LOW renin HTN
Hypokalemia
Metabolic Alkalosis

38
Q

Where are Paragangliomas?

A

Outside the adrenal gland

39
Q

What can Paragangliomas secrete? (although they do not have to)

A

Catecholamines

40
Q

What tumor will present identically to a Pheochromocytoma?

A

Paragangliomas

41
Q

How do you test for Pheochromocytomas/Paragangliomas?

A

Plasma fractionated free metanephrines

42
Q

Paragangliomas will present like?

A

Pheochromocytomas

= paroxysmal HTN, headaches, palpitations, sweating

43
Q

How will the patient present after the paroxysmal attack of a pheochromocytoma or paraganglioma?

A

Pallor

44
Q

When treating a Pheochromocytoma, what should always be given first?

A

Alpha Blocker

45
Q

What can be given after the Alpha Blocker when treating Pheochromocytomas?

A

Beta blocker

46
Q

What happens if you give a beta blocker before an alpha blocker with a pheochromocytoma?

A

It can raise the BP even higher

47
Q

How is Von Hippel Lindau Type 2 disease inherited and what 3 things can present?

A

AD

= Pheochromocytoma + hemangioblastoma of cns/eye + RCC

48
Q

What is an Adrenal Gland Incidentaloma?

A

Mass found incidentally when patient is getting an abdominal CT/MRI for another reason

49
Q

Most Adrenal Gland Incidentalomas are benign but if they are > 4 cm or if the patient has a history of malignancy they should be _____

A

Resected

50
Q

What 3 things should you assess for if you find an Adrenal Gland Incidentaloma?

A

Cushing Syndrome
Hyperaldosteronism
Pheochromocytoma

ENRP - Exam 2 (21 decks)

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