Quiz

Question 1

In undiagnosed patients in an Addisonian crisis needing immediate treatment , which corticosteroid is preferred and why?

Answer 1

Dexamethasone

It doesn’t interfere with ACTH stimulation testing

Question 2

What is the preferred therapy for Addison’s disease?

Answer 2

Hydrocortisone (first line) 15-25mg/day in 3 divided doses

+ Fludrocortisone 0.05-0.2mg/day

Question 3

List genetic susceptibilities associated with PGA-II:

Answer 3

HLA-DR3 and HLA-DR4

Question 4

What disorders make up Schmidt’s syndrome? What is the difference between Schmidt’s and PGA-II?

Answer 4

Schmidt’s: Addison’s disease + autoimmune thyroid disease

PGA-II consists of Addison’s disease + autoimmune thyroid disease and/or T1DM

Question 5

What is the most common autoimmune thyroid disorder associated with PGA-II?

Answer 5

Hashimoto’s

Question 6

How do you treat to euthyroid in Hashimoto’s?

Answer 6

Six weeks after initial dose, assess the TSH levels, and if needed adjust dose in increments of 12-25 mcg every 6-8 weeks until euthyroid

Question 7

What are two important counseling points to remember when treating a patient with glucocorticoids, as we do in Addison’s disease. (Hydrocortisone and Fludrocortisone)?

Answer 7

In case of concurrent illness, increase the doses of hydrocortisone.
Do not exceed 30mg/dose in patients with diabetes because it may necessitate higher insulin doses (helpful memory aid: you have to deal with the added GLUCO-corticoids)

Question 8

Briefly define “orthostatic hypotension”.

Answer 8

Low blood pressure on standing up (orthostatic, or postural, hypotension). This is a sudden drop in blood pressure when you stand up from a sitting position or if you stand up after lying down.

Question 9

Assessment of the _________ and ___________ of the affected joints along with an Anti-________ _________ __________ (anti-CCP) assay are both used to aid in diagnosis and differentiation of Rheumatoid Arthritis.

Answer 9

number; size

cyclic citrullinated peptide

Question 10

What are the true names of the hormones T3 and T4?

Answer 10

T4 = Thyroxine
T3 = Triiodothyronine

Question 11

Name three symptoms of Addison’s disease

Answer 11

Muscle weakness
Weight loss
Hyperpigmentation
Abdominal Pain
Depression
Fatigue
N/V/D
Hypotension
Crave salty foods
Dizziness

Question 12

Describe the symptoms of an Addisonian crisis

Answer 12

Exaggerated symptoms of Addison’s disease
Severe dehydration
Sharp sudden pains in the legs, abdomen, and lower back (lower body)

Question 13

In what range would you expect to find Cortisol and ACTH in a patient with Addison’s?

Answer 13

Cortisol severely below reference range (should be less than 3 units)
ACTH would likely be elevated above reference range

Question 14

Name 3 causes of adrenal insufficiency other than Addison’s Disease

Answer 14

Abrupt end of prolonged corticosteroid therapy
Tuberculosis (fyi - this may trigger Addison’s)
Cancer

Question 15

Where is Dr. Astreinidis from? What is he researching?

Answer 15

Thessalonica, Greece

Sporadic pulmonary lymphangioleiomyomatosis

Question 16

How is levothyroxine excreted?

Answer 16

Mainly through the urine but some through feces

Question 17

What are some herbal or dietary supplements that can be used to help with thyroid dysfunction?

Answer 17

Iodine
Gingko biloba
L-carnitine
Seaweed
Selenium

Question 18

What is the pathophysiology of Schmidt’s?

Answer 18

It is an autoimmune disorder that causes the destruction of glands at different times based on the type, APS II or PGA II.

Question 19

How does hypotension present?

Answer 19

Lowered BP
Light-headed/fainting/lack of concentration
Cold clammy and pale skin
Fatigue
Depression

Question 20

Schmidt’s is more common in who?

Answer 20

Females

30’s or 40’s

Question 21

Name the two home otc/herbal medications that JC was taking in the beginning of the case?

Answer 21

St. John’s Wort 300mg PRN, APAP

Question 22

Discuss JC’s dietary changes in response to his underlying illness.

Answer 22

His lack of mineralocorticoids has led to sodium loss, and lately he has been craving salty foods. He has responded by eating more chips and pretzels.

Question 23

Why is levothyroxine better than thyroxine for PO treatment of hypothyroidism?

Answer 23

Levothyroxine does not undergo the extensive first hepatic metabolism seen with thyroxine

Question 24

Name two distinct signs/symptoms of Addison’s crisis:

Answer 24

Severe dehydration, sharp sudden pain in lower body

Question 25

Outline a corticosteroid maintenance treatment after suffering from Addison’s Crisis:

Answer 25

Hydrocortisone 10 mg in morning, 5 mg at noon, 5 mg in afternoon

Question 26

A diagnosis of hypotension is __________ __________, which is the action of attempting to exhale with the nostrils and mouth closed; this increases pressure in the middle ear and the chest.

Answer 26

Valsalva Maneuver

Question 27

What are signs and symptoms of hypotension (select 3)?

Answer 27

lowered blood pressure
light-headed/fainting
lack of concentration
fatigue
depression

Question 28

What causes hypotension (select 3)?

Answer 28

anemia
pregnancy
drugs
dehydration
cardiac issues (arrhythmias, CHF)
anxiety

Question 29

Which drugs cause hypotension (select 3)?

Answer 29

alcohol
narcotics
sedatives
diuretics
TCAs

Question 30

What does PGA-II stand for?

Answer 30

Polyglandular Autoimmune Syndrome Type 2