Peds Adrenal Glands

Question 1

What 5 things does angiotensin lead to/do?

Answer 1

Gets you to drink, vasoconstriction, aldosterone, increases sympathetic, directly increases reabsorption of sodium and water, ADH.

Question 2

Big picture, what is our short term stress response?

Answer 2

Catecholamines

Question 3

What is our long term stress response?

Answer 3

Glucos and minerals

Question 4

Is a drop in blood pressure associated with short term dehydration of longer term?

Answer 4

Longer term

Question 5

What is going on with the following labs for CAH?

Sodium, potassium, chloride, bicarb, BUN, creatine and glucose?

Answer 5

Down, up, down, down, up, normal, down.

Question 6

What are the three things you do/give for treatment of CAH?

Answer 6

Hydrocortisone, fluids/glucose, and get potassium down (give insulin)

Question 7

What 3 enzymes are screened for to check for CAH at birth?

Answer 7

21 hydroxylase, 17 alpha hydroxylase, and 11 beta hydroxylase

Question 8

What is the most common cause of primary adrenal insufficiency?

Answer 8

Autoimmune

Question 9

What is the most common infectious cause of primary adrenal insufficiency and what will you see on imaging?

Answer 9

TB

Calcification

Question 10

Why does increased ACTH lead to hyperpigmentation fo the skin?

Answer 10

Melano stimulating hormone is a cleaved product of ACTH

Question 11

6 clinical symptoms in nearly all patients with primary adrenal insufficiency?

Answer 11

Fatigue, reduced stamina, weakness, anorexia, weight loss, and skin hyperpigmentation.

Question 12

4 lab values for primary adrenal insufficiency and what is the confirmatory test?

Answer 12

Low sodium, high potassium, low glucose, and a low 8 am cortisol accompanied by elevated ACTH
Cortisol levels not responding to synthetic acth

Question 13

What serum marker will confirm diagnosis of autoimmune Addison?

Answer 13

Antibodies to 21 hydroxylase

Question 14

What serum marker is required for diagnosis of 21 hydroxylase deficiency?

Answer 14

It’s precursor 17 OH progesterone

Question 15

Why would plasma renin be elevated in primary adrenal insufficiency?

Answer 15

Because of the low blood volume

Question 16

What are the acute adrenal crisis symptoms?

Answer 16

Triple H fan

Question 17

What lab values are a dead give away for secondary adrenal insufficiency?

Answer 17

Low serum acth with low serum cortisol

Question 18

What imaging technique would you use for ACTH independent Cushing and ACTH dependent?

Answer 18

CT of adrenals

MRI of pituitary

Question 19

What is an adrenal incidentaloma?

Answer 19

Adrenal nodule discovered incidentally on abdominal CT or MRI

Question 20

What size of mass are we thinking malignancy?

Answer 20

Greater than 4 cm

Question 21

If we see a mass, what should all patients be assessed for?

Answer 21

Cushings, hyperaldosteronism, and pheo

Question 22

What is conn syndrome?

Answer 22

Aldosterone producing adenoma

Question 23

40% of conn syndrome patients have what mutation?

Answer 23

Potassium channel

Question 24

3 common clinical symptoms of hyperaldosteronism?

Answer 24

HTN and hypokalemia and metabolic alkalosis

Question 25

What do all patients with primary hyperaldosteronism require?

Answer 25

CT scan of adrenals to check for adrenal carcinoma

Question 26

What is a paraganglioma and what is the difference between it and conventional pheochromocytoma?

Answer 26

Para is an extra adrenal pheo.

Only secretes norepi.

Question 27

What syndrome does he want us to know associated with pheo and what is the inheritance pattern?

Answer 27

VHL type 2

Autosomal dominant

Question 28

What is the single most sensitive test for secretory pheo and paras?

Answer 28

Plasma fractionated free metanephrines

Question 29

First line treatment of choice for pheo?

Answer 29

Alpha blockers

Question 30

What is the inheritance patterns for men syndromes?

Answer 30

Autosomal dominant