Unrein, addisons, cushings

Question 1

cortisol level in addisons

Answer 1

low normal basal secretion

Question 2

how can someone be physiologically normal with cortisol metabolism with either high or low serum cortisol

Answer 2

cortisol is protein bound

Question 3

how do you Dx addisons

Answer 3

ACTH stimulation test (cosryntropin stim test)

Question 4

ACTH stimulation test in primary adrenal insufficiency

Answer 4

no change because problem is in adrenal

Question 5

ACTH in secondary adrenal insufficiency

Answer 5

see a change because problem in pituitary

Question 6

most common form adrenal insufficiency

Answer 6

iatrogenic- exogenous steroids

Question 7

BMP in someone with adrenal insufficiency

Answer 7

low Na, high K
hypoglycemia
metabolic acidosis
volume depletion

Question 8

how to distinguish between primary and secondary adrenal insufficiency

Answer 8

secondary does not have hyperpigmentation or the severity of electrolyte abnormalities

Question 9

46 y.o F has noncompliant BP, hypokalemia
on lisinpril HCTZ and K replacement
labs unremarkable
bicarb high
suspect?

Answer 9

mineralocorticoid excess

Question 10

29 F with proximal mm weakness, weight gain, dorsal fat pad, round face, abdominal striae
menstrual irregularities
high glucose low K
what lab needed to Dx?

Answer 10

24 hr urine cortisol

Question 11

DXM suppression test used for what

Answer 11

to distinguish exogenous ACTH production vs pituitary ACTH secretion

Question 12

low dose DXM suppresses what

high dose DXM suppress what

Answer 12

low dose neither

high dose DXM suppresses pituitary, cannot suppress exogenous

Question 13

56 M dry cough hoarseness, weight loss, increased weakness, unexplained weight loss
COPD on prednisone
moon facies, truncal obesity, bruising on arms
low K high glucose high urine cortisol
next step in evaluation?

Answer 13

CT scan of the chest

Question 14

55 y.o M hospitalized pyelonephritis
albuterol, fluticasone, salmeterol, lisinopril and prednisone
Na low, glucose little high
hypotensive
on antibiotics for pyelonpehritis
what else should you do?

Answer 14

iatrogenic adrenal insufficiency

needs stress dose of steroids– hydrocortisone

Question 15

how long is someone considered to have adrenal suppression after prolonged course of steorids?

Answer 15

one year

Question 16

28 y.o F started thyroid replacement hormone for tSH
BP 122/72
BMI22 skin unremarkable
to start levothyroxine, what test can you use to be sure it is safe to start Tx

Answer 16

normal serum Na K and glucose

tells you adrenal-pituitary axis is in tact, safe to start on thyroid replacement

Question 17

43 y.o F 148/98 BP, high Na low K, high Cl, high glucose, CT show unremarkable adrenal glands
seeing chines herbologist to Tx depression
what finding do you need to confirm Dx?

Answer 17

licorice in chinese herbs

pseudohyperaldosteronism

Question 18

aldosterone renin levels in primary hyepraldosteronism

Answer 18

high serum aldosterone and low serum renin

Question 19

aldosterone renin levels in secondary hyperaldosteronism

Answer 19

high serum aldosterone and high serum renin

Question 20

22 y.o M hypotension and unconsciousness. sore thraoat, purpuric rash on palms and soles and HA
smoke 5 pack years
no vaccines
CT on chest you expect to find

Answer 20

waterhouse-friederichson syndrome
- could have meningitis, coxsackie, rickettsia, syphilis
Tx with antibiotics and lumbar puncture for culture. also need steroids to Tx meningitis

Question 21

45 y.o M with fatigue
10 yrs ago had tanssphenoidal hypophysectomy for removal pituitary adenoma
small testes
what test to you order to evaluate fatigue?

Answer 21

serum free cortisol and free T4

want to know if being Tx with enough exogenous hormones