Week 1 Flashcards by B. Smith

What should prompt a work up of mineralocorticoid excess?

HTN with hypokalemia

How well did you know this?

Not at all

Perfectly

What do you expect to see in primary hyperaldosterism? (aldosterone / renin)

increased aldosterone

decreased renin

How well did you know this?

Not at all

Perfectly

What do you expect to see in renal artery stenosis? (renin / aldosterone)

Both increased since kidneys are not being perfused well enough

How well did you know this?

Not at all

Perfectly

What do you expect to see in renin producing adenoma?

increased renin and increased aldosterone

How well did you know this?

Not at all

Perfectly

What do you expect to see in increased cortisol? (aldosterone / renin)

aldosterone and renin decrease (don’t want an even higher BP)

How well did you know this?

Not at all

Perfectly

What do you expect to see in increased DOC? (aldosterone / renin)

it acts like a mineralocorticoid

so you would expect decreased renin and decreased aldosterone

How well did you know this?

Not at all

Perfectly

What do you expect to see in Liddle syndrome?(aldosterone / renin)

decreased aldo and renin since ENaC function is already increased

How well did you know this?

Not at all

Perfectly

What is a form of secondary hyperaldosteronism?

renal artery stenosis causes (high renin and high aldosterone)

How well did you know this?

Not at all

Perfectly

What is the treatment for hyperaldosteronism if there is a bilateral adenoma?

spironolactone

How well did you know this?

Not at all

Perfectly

How can you determine between the classic and non-classic form of CAH?

classic is much more severe and presents early with cortisol deficiency, aldosterone deficiency and excess adrenal hormones

How well did you know this?

Not at all

Perfectly

What can males with classic CAH develop?

early virilization

How well did you know this?

Not at all

Perfectly

What is elevated in 21a-hydroxylase def?

androgens

How well did you know this?

Not at all

Perfectly

What is elevated in 11B-hydroxylase def?

androgens

(you do not see aldosterone def. because it blocks lower down in the pathway)

How well did you know this?

Not at all

Perfectly

What is elevated in 17a-hydroxylase deficiency?

aldosterone is increased since you can’t shunt to make cortisol (fasc.) or androgens (retic.)

How well did you know this?

Not at all

Perfectly

What types of glucocorticoids should be avoided in pregnancy?

dexamethasone

How well did you know this?

Not at all

Perfectly

What is the inheritance pattern of CAH?

autosomal recessive

How well did you know this?

Not at all

Perfectly

CYP21A2 is implicated in

CAH

How well did you know this?

Not at all

Perfectly

What are the three tests for Cushing’s syndrome? (remember that 2 out of 3 need to be positive)

1mg overnight dex suppression test
24-hour urine free cortisol
Midnight salivary cortisol

How well did you know this?

Not at all

Perfectly

If a low dose dex suppression test does not decrease ACTH what do you know is true?

you have a ACTH-dependent Cushing’s syndrome

How well did you know this?

Not at all

Perfectly

What is the next step for a ACTH-dependent Cushing’s syndrome?

use a high dose dex. suppression test

if ACTH decreases, you have a pituitary adenoma

if ACTH does not decrease, you have ectopic ACTH

How well did you know this?

Not at all

Perfectly

Can you see hypokalemia in Cushings?

yes!

How well did you know this?

Not at all

Perfectly

What are causes of low ACTH Cushing’s syndrome?

Adrenal adenomas

Exogenous steriods

How well did you know this?

Not at all

Perfectly

What are causes of high ACTH Cushing’s syndrome?

Cushing’s disease

Ectopic ACTH

How well did you know this?

Not at all

Perfectly

What are you at risk with following removal of adrenal gland s/o low ACTH Cushings?

secondary adrenal insufficiency

(low levels of ACTH since the pituitary is not used to having to produce them)

How well did you know this?

Not at all

Perfectly

What does plasma ACTH do in adrenal adenoma?

it is low since cortisol is being secreted in high amounts by the adrenal adenoma

What drugs can you use if surgery is not an option in Cushings?

ketoconazole

What type of tumor results in high levels of epinephrine and norepinehprine?

pheochromoctyoma

Does 21a-hydroxylase def cause both non-classic and classic CAH?

yes

What is the pre-op management for pheos?

alpha blocker then a beta blocker along with volume expansion

What happens when you suddenly withdrawal exogenous steroids?

you have low ACTH and low cortisol levels (secondary adrenal insufficiency) the body is not used to producing these things

Name 3 alpha 1 blockers

phenoxybenzamine, doxazosin, prazosin

Do you see hypertension or hypotension in Addison's ?

hypotension from lack of cortisol

Do you see hypertension or hypotension in ectopic ACTH?

hypertension, you are excreting too much cortisol

What is the link between cortisol and ADH?

cortisol deficiency can cause increased release of ADH

If you involve the pituitary stalk and posterior pituitary what can you develop?

SIADH

What form of disease is Klinefelter's?

primary hypogonadism

What testing should you do for Klinefelters?

testosterone in morning karotype for confirmation (47XXY)

What hormones (FSH/LH and testosterone) do you see in Klinefelters?

low testosterone (underdeveloped testes) high FSH / LH

What hormones (FSH/LH and testosterone) do you see in secondary hypogonadism?

low testosterone low FSH / LH

What hormones (FSH/LH and testosterone) do you see in anabolic steroids?

low testosterone low FSH / LH (the body thinks testosterone is there)

What signs should you look for in hypercalcemia?

stones, bones, moans, grones and psychiatric overtones also on the throne (polyuria)

What happens to reflexes in hypocalciuria?

become hyperreflexive due to increased calcium raising the membrane threshold

What 2 mechanisms cause polyuria (and dehydration) in hypercalciema?

1) osmotic diuresis from more calcium in urine 2) calcium inhibits ADH receptors

What are the 3 differentials for PTH-mediated hypercalecemia?

1) Primary hyperparathyroidism 2) Familial hypocalciuric hypercalcemia (FHH) 3) Tertiary hyperparathyroidism (only in ESRD)

What is true of FHH?

it is protective against kidney stones

What should be the first step in working up hypercalcemia?

1) measure PTH levels

If you have PTH dependent hyperparathyroidism (high / normal PTH), what should be next test?

24 hr urine Cr and Ca

Do you need to treat FHH?

What two conditions does 24 hr urine Cr and Ca separate?

1) High urine Cr / Ca = primary hyperparathyroidism 2) Low urine Cr / Ca = FHH

What do you expect labs to look like if they are from malignancy, sarcoidosis or excessive calcium?

these are PTH independent processes so you would see increased calcium with a low PTH (the PTH is not what is driving the increase in calcium)

What 2 signs are seen in hypocalcemia?

1) CHVOSTEK’S SIGN: facial contraction 2)TROUSSEAU’S SIGN: spazing after placing the BP cuff

What other lab do you always need to check with calcium?

albumin (albumin binds free calcium)

What can hypocalcemia cause on EKG?

prolongation of QT interval

What accounts for most causes of primary hypercalciema?

malignancy

What does PTH look like in primary hypercalciema?

low (PTH is responding normally)

When is hypocalciema due to hypoparathyroidism mostly seen?

after thyroid or parathyroid surgery

What does vitamin D deficiency lead to?

defect in skeletal mineralization

What is the relationship between vitamin D deficiency and PTH?

since vitamin D impairs absorption of Ca2+, PTH increases

What is the relationship between vitamin D deficiency and phosphate?

see a decreased phosphate level

Gastrinoma should make you think ...

MEN1

What are 3 secondary causes of bone loss?

1) vitamin D deficiency 2) hyperparathyroidism 3) hyperthyroidism (low TSH with high T4)

Thyroid tumor should make you think ...

MEN2

What type of parathyroid does a tumor secrete (like squamous cell)?

PTHrP (then, low PTH)

What can MEN1 cause in endocrine?

primary hyperparathyroidism with a prolactinoma

How do you remember where MEN1 can manifest?

the 3Ps