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Block 10 Week 2 > TBL Endocrine > Flashcards

TBL Endocrine Flashcards

1
Q

In what ways do secondary forms of hypertension, which are endocrine in origin differ from essential hypertension in which an etiology can be identified?

A

abrupt onset
greater severity
no positive family history of HTN
no specific age criterion

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2
Q

List 3 endocrine diseases that can cause secondary HTN

A

primary hyperaldosteronism
Cushing’s disease
pheochromocytoma

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3
Q

Explain the concept of pseudoresisitance

A

when medications cause tachycardia, volume expansion, and/or RAAS activation –> plasma volume expansion

can occur with alpha & beta blockers or direct vasodilators

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4
Q

What is a pheochromocytoma?

A

a tumor of chromaffin cells of the adrenal medulla –> excess secretion of catecholamines –> increased BP & other symptoms

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5
Q

When are most pheochromocytomas detected?

A

during surgery or abdominal imaging

or during autopsy

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6
Q

Pheochromocytoma can be associated with this disease

A

neurofibromatosis

**pts with neurofibromatosis should be screened for pheo

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7
Q

What is the triad of symptoms of a pheochromocytoma?

A

headache
excessive/generalized sweating
palpitations

**other symptoms: pallor, weight loss, feelings of panic & anxiety

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8
Q

What types of blood pressure patterns can emerge with a pheochromocytoma?

A

sustained HTN without BP spikes
persistent HTN state w spikes reaching crisis level
normotensive state with brief & sudden spikes in BP

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9
Q

(blank) is seen in more than 50% of pts with pheochromocytoma

A

orthostatic hypotension

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10
Q

What are the symptoms of a pheochromocytoma-related hypertensive crisis?

A 
dizziness
flushing
visual disturbances
panic/anxiety
nausea
vomiting
epileptic aura
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11
Q

What are some diseases that can present like pheochromocytoma?

A 
paroxysmal vasodilating headaches
autonomic dysfunction
anxiety or panic disorder
acute hypoglycemia
CAS
cocaine use
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12
Q

What is necessary for the diagnosis of pheochromocytoma?

A

evidence of excess catecholamine production

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13
Q

What tests do you use to diagnose pheo?

A

measure urine & plasma catecholamines

urine metanephrines & vanillylmandelic acid

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14
Q

The best approach for pheochromocytoma screening

A

looking at catecholamines & their metabolites in timed urinary samples

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15
Q

The most sensitive test for pheochromocytoma

A

plasma free metanephrines

**O-methylated metabolites of catecholamines are continuously seeping from chromaffin tumors

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16
Q

T/F: Measurements of fractionated metanephrines are better than total metanephrines

A

True

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17
Q

What can you do if catecholamine levels are elevated but not that much?

A

give a clonidine suppression test –> if pheochromocytoma, clonidine would not suppress catecholamine release

**failure to suppress plasma catecholamines after clonidine therapy –> pheo

18
Q

What kinds of imaging can be used for pheo?

A

MRI & CT

I-metaiodobenzylgaunidine (for more specificity)

19
Q

The only effective therapy approach for pheo?

A

surgical treatment

20
Q

This is essential during surgical removal of pheo…

A

alpha & beta blockers

21
Q

This should be considered in any patient with spontaneous hypokalemia, moderately severe hypokalemia after using normal doses of diuretics, or refractory HTN

A

primary hyperaldosteronism

22
Q

Does primary aldosteronism cause edema?

A

no, because of aldosterone escape

23
Q

Patients with primary hyperaldosteronism often develop this comorbid condition

A

left ventricular hypertrophy –> heart failure

24
Q

What other diseases present like primary hyperaldosteronism?

A

SIADH
Liddle’s syndrome
licorice ingestion

25
Q

(blank) ingestion increases access of cortisol to its receptor and causes Na+ retension & K+ loss

A

licorice

26
Q

How to diagnose primary hyperaldosteronism?

A

low K+ in serum
abnormally high K+ in urine
reduced renin activity
elevated plasma/urine aldosterone

27
Q

How to treat hyperaldosteronism?

A

remove an adenoma
medical therapy with spironolactone in pts with bilateral adrenal hyperplasia or high operative risk
Eplerenone is a newer option

28
Q

What’s Cushing’s syndrome?

A

excess cortisol production

29
Q

Two types of Cushing’s syndrome

A

ACTH-dependent & ACTH independent

30
Q

What causes 80% of ACTH dependent Cushings syndome?

A

ACTH secreting adenoma

can also be caused by an ACTH secreting small cell carcinoma of the lung

31
Q

What causes the ACTH independent forms of Cushings syndrome?

A

adrenal adenoma or carcinoma

32
Q

Signs & symptoms of Cushing’s disease

A 
buffalo hump
hypertension (increased beta receptors on blood vessels --> increased tone of vasculature)
moon face
proximal weakness
hirtuism
emo distubances
skin abnormalities
insulin resistance 
osteoporosis
loss of libido
33
Q

Increased (blank) risk in Cushings patients

A

cardiovascular

34
Q

How do pts with ectopic ACTH secretion differ from pts with Cushings caused by increased cortisol secretion?

A

may not have typical symptoms of cortisol excess
instead, skin hyperpigmentation due to MSH overproduction
severe hypertension
hypokalemic alkalosis

35
Q

Most common cause of Cushing’s syndrome?

A

exogenous steroid administration

36
Q

Things that present like Cushings…

A

fat people with metabolic syndrome & cushingoid appearance

chronic alcohol excess

37
Q

Best test for diagnosing Cushing’s syndrome?

A

24 hr free cortisol

**amount of free cortisol in urine can be decreased by renal disease

38
Q

Test widely used to screen for Cushing’s syndrome

A

dexamethasone suppression test –> exogenous dexamethasone should reduce plasma cortisol values to less than 2 in normal patients

**measure urinary free cortisol as a confirmation test

39
Q

How to treat Cushing’s syndrome?

A

excise the pituitary adenoma

can do adrenalectomy if adrenal adenoma or carcinoma

medical management with ketoconazole if all else fails

40
Q

Other causes of Cushing’s disease

A

insulin resistance
sleep apnea

**both contribute to HTN

41
Q

T/F: Hypertension generally remits with corrective surgery of Cushing’s syndrome unless exposure to excess cortisol has been sufficiently prolonged

A

True

42
Q

(blank) should be avoided in pts with Cushing’s syndrome since they increase Ca++ excretion which can exacerbate the negative Ca++ balance state in Cushing’s

A

loop diuretics

Block 10 Week 2 (8 decks)

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