Quiz Flashcards
In undiagnosed patients in an Addisonian crisis needing immediate treatment , which corticosteroid is preferred and why?
Dexamethasone
It doesn’t interfere with ACTH stimulation testing
What is the preferred therapy for Addison’s disease?
Hydrocortisone (first line) 15-25mg/day in 3 divided doses
+ Fludrocortisone 0.05-0.2mg/day
List genetic susceptibilities associated with PGA-II:
HLA-DR3 and HLA-DR4
What disorders make up Schmidt’s syndrome? What is the difference between Schmidt’s and PGA-II?
Schmidt’s: Addison’s disease + autoimmune thyroid disease
PGA-II consists of Addison’s disease + autoimmune thyroid disease and/or T1DM
What is the most common autoimmune thyroid disorder associated with PGA-II?
Hashimoto’s
How do you treat to euthyroid in Hashimoto’s?
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
What are two important counseling points to remember when treating a patient with glucocorticoids, as we do in Addison’s disease. (Hydrocortisone and Fludrocortisone)?
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)
Briefly define “orthostatic hypotension”.
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.
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.
number; size
cyclic citrullinated peptide
What are the true names of the hormones T3 and T4?
T4 = Thyroxine T3 = Triiodothyronine
Name three symptoms of Addison’s disease
Muscle weakness Weight loss Hyperpigmentation Abdominal Pain Depression Fatigue N/V/D Hypotension Crave salty foods Dizziness
Describe the symptoms of an Addisonian crisis
Exaggerated symptoms of Addison’s disease
Severe dehydration
Sharp sudden pains in the legs, abdomen, and lower back (lower body)
In what range would you expect to find Cortisol and ACTH in a patient with Addison’s?
Cortisol severely below reference range (should be less than 3 units)
ACTH would likely be elevated above reference range
Name 3 causes of adrenal insufficiency other than Addison’s Disease
Abrupt end of prolonged corticosteroid therapy
Tuberculosis (fyi - this may trigger Addison’s)
Cancer
Where is Dr. Astreinidis from? What is he researching?
Thessalonica, Greece
Sporadic pulmonary lymphangioleiomyomatosis
How is levothyroxine excreted?
Mainly through the urine but some through feces
What are some herbal or dietary supplements that can be used to help with thyroid dysfunction?
Iodine Gingko biloba L-carnitine Seaweed Selenium
What is the pathophysiology of Schmidt’s?
It is an autoimmune disorder that causes the destruction of glands at different times based on the type, APS II or PGA II.
How does hypotension present?
Lowered BP Light-headed/fainting/lack of concentration Cold clammy and pale skin Fatigue Depression
Schmidt’s is more common in who?
Females
30’s or 40’s
Name the two home otc/herbal medications that JC was taking in the beginning of the case?
St. John’s Wort 300mg PRN, APAP
Discuss JC’s dietary changes in response to his underlying illness.
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.
Why is levothyroxine better than thyroxine for PO treatment of hypothyroidism?
Levothyroxine does not undergo the extensive first hepatic metabolism seen with thyroxine
Name two distinct signs/symptoms of Addison’s crisis:
Severe dehydration, sharp sudden pain in lower body
Outline a corticosteroid maintenance treatment after suffering from Addison’s Crisis:
Hydrocortisone 10 mg in morning, 5 mg at noon, 5 mg in afternoon
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.
Valsalva Maneuver
What are signs and symptoms of hypotension (select 3)?
lowered blood pressure light-headed/fainting lack of concentration fatigue depression
What causes hypotension (select 3)?
anemia pregnancy drugs dehydration cardiac issues (arrhythmias, CHF) anxiety
Which drugs cause hypotension (select 3)?
alcohol narcotics sedatives diuretics TCAs
What does PGA-II stand for?
Polyglandular Autoimmune Syndrome Type 2
