Peds Adrenal Glands Flashcards
What 5 things does angiotensin lead to/do?
Gets you to drink, vasoconstriction, aldosterone, increases sympathetic, directly increases reabsorption of sodium and water, ADH.
Big picture, what is our short term stress response?
Catecholamines
What is our long term stress response?
Glucos and minerals
Is a drop in blood pressure associated with short term dehydration of longer term?
Longer term
What is going on with the following labs for CAH?
Sodium, potassium, chloride, bicarb, BUN, creatine and glucose?
Down, up, down, down, up, normal, down.
What are the three things you do/give for treatment of CAH?
Hydrocortisone, fluids/glucose, and get potassium down (give insulin)
What 3 enzymes are screened for to check for CAH at birth?
21 hydroxylase, 17 alpha hydroxylase, and 11 beta hydroxylase
What is the most common cause of primary adrenal insufficiency?
Autoimmune
What is the most common infectious cause of primary adrenal insufficiency and what will you see on imaging?
TB
Calcification
Why does increased ACTH lead to hyperpigmentation fo the skin?
Melano stimulating hormone is a cleaved product of ACTH
6 clinical symptoms in nearly all patients with primary adrenal insufficiency?
Fatigue, reduced stamina, weakness, anorexia, weight loss, and skin hyperpigmentation.
4 lab values for primary adrenal insufficiency and what is the confirmatory test?
Low sodium, high potassium, low glucose, and a low 8 am cortisol accompanied by elevated ACTH
Cortisol levels not responding to synthetic acth
What serum marker will confirm diagnosis of autoimmune Addison?
Antibodies to 21 hydroxylase
What serum marker is required for diagnosis of 21 hydroxylase deficiency?
It’s precursor 17 OH progesterone
Why would plasma renin be elevated in primary adrenal insufficiency?
Because of the low blood volume
What are the acute adrenal crisis symptoms?
Triple H fan
What lab values are a dead give away for secondary adrenal insufficiency?
Low serum acth with low serum cortisol
What imaging technique would you use for ACTH independent Cushing and ACTH dependent?
CT of adrenals
MRI of pituitary
What is an adrenal incidentaloma?
Adrenal nodule discovered incidentally on abdominal CT or MRI
What size of mass are we thinking malignancy?
Greater than 4 cm
If we see a mass, what should all patients be assessed for?
Cushings, hyperaldosteronism, and pheo
What is conn syndrome?
Aldosterone producing adenoma
40% of conn syndrome patients have what mutation?
Potassium channel
3 common clinical symptoms of hyperaldosteronism?
HTN and hypokalemia and metabolic alkalosis
What do all patients with primary hyperaldosteronism require?
CT scan of adrenals to check for adrenal carcinoma
What is a paraganglioma and what is the difference between it and conventional pheochromocytoma?
Para is an extra adrenal pheo.
Only secretes norepi.
What syndrome does he want us to know associated with pheo and what is the inheritance pattern?
VHL type 2
Autosomal dominant
What is the single most sensitive test for secretory pheo and paras?
Plasma fractionated free metanephrines
First line treatment of choice for pheo?
Alpha blockers
What is the inheritance patterns for men syndromes?
Autosomal dominant
