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ENRP > Week 5 (Exam 2) > Flashcards

Week 5 (Exam 2) Flashcards

1
Q

Acute adrenal crisis treatment

A

HYDROCORTISONE!
FLUIDS/GLUCOSE
treat hyperkalemia if needed

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2
Q

Confirmatory test of primary adrenal insufficiency

A

Cosyntropin (synthetic ACTH) stimulation test

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3
Q

11 B-HSD2 inhibitors

A

Too much active steroid

Glycyrrhizin (licorice), Carbenoxolone

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4
Q

Long-acting (greater than 36 hr) adrenal corticosteroid drugs

A

Betamethasone

Dexamethasone

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5
Q

Adrenal Destruction (Addison’s) causes

A

Autoimmune (most common)
X-Recessive (can mimic MS)
Tb!!
Waterhouse Friderichsen!!

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6
Q

Conn Syndrome

A

Unilateral aldosterone producing adrenal adenoma

40% have mut K channel, makes Metabolic Alkalosis

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7
Q

SAME: syndrome of apparent mineralocorticoid excess

A

11b-HSD2 deficiency (can also be caused by licorice)
Cortisol activates renal aldosterone. AD.
Child with HTN, Hypokalemia, Metabolic alkalosis
Low aldosterone and low renin
Low urinary free cortisone

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8
Q

McCune Albright Syndrome

A

Bilateral primary adrenocrotical hyperplasia

Polycystic fibrous dysplasia, cafe-au-lait spots, endocrine hyper function from multiple organs

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9
Q

MEN2b symptoms

A 
Mucosal Neuromas
Marfanoid Body Habitus
Medullary Thyroid CA
Pheochromocytoma
(Gain of function RET)
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10
Q

Low serum ACTH in setting of low serum cortisol

A

Secondary adrenal insufficiency

Alabster skin: decreased pigmentation secondary to decreased secretion of a-MSH

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11
Q

Inherited adrenal unresponsiveness to ACTH (Addison’s) causes

A

Familial glucocorticoid deficiency (AR): Pigmentation
Isolated cortisol def., Mineralocorticoid normal, ACRH r.
AAA (Allgrove) Syndrome: mut ALADIN protein
Alacrima, achalasia, adrenal insuffiency, neuro disorder

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12
Q

Eplerenone

A

Mineralocorticoid receptor antagonist mainly
Tx HTN and prevents CV events
Cleared by P450(CYP3a4), eliminated 3-6 hours
Steady state within 2 days
Adverse: Hyper-K and increased creatinine

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13
Q

Mitotane

A

Can treat adrenal cortical carcinoma

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14
Q

Treatment for 21-hydroxylase (congenital adrenal hyperplasia) deficiency

A

Hydrocortisone
Fluids/Glucose
Get K levels down

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15
Q

MEN1 symptoms

A

Pituitary adenoma
Parathyroid Hyperplasia
Pancreatic Tumors
(Loss of function MEN1)

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16
Q

Distinguish primary vs 2/3 addisons

A

1: Hyperpigmentation, Hyper-K, responds to metyrapine
2/3: No hyperpigmentation, normal K, No ACTH response to metyrapine
3: ACTH response with CRH

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17
Q

Pheochromocytoma vs Paragangliomas

A

Pheochromocytoma: From adrenal medulla, secrete Epi and nor-epi
Paragangliomas: often metastasize, secrete nor-epic or nothing

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18
Q

Ezyme deficiency labs

A

21-hydroxylase: Aldosterone down, Test up
17-a-hydroxylase: aldosterone up, Test down
11-b-hydroxylase: aldosterone up, test up

19
Q

Anti-Insulin action consequences of glucocorticoids

A

all leads to hyperglycemia
Increased liver gluconeogenesis, decreased adipose glucose uptake, increased lipolysis, Decreased skeletal m. glucose intake and glycogen synthetase, more proteolysis

20
Q

Ectopic ACTH syndrome

A

Small Cell Ca of the Lung!

21
Q

Short to medium acting adrenal corticosteroid drugs (shorter than 12 hr)

A

Hydrocortisone (cortisol)

Cortisone

22
Q

GRA: glucocorticoid remediable aldosteronism

A

Leads to familial hyperaldosteronism. AD
Aberrant expression of aldosterone synthase
Child with HTN, Hypokalemia, metabolic alkalosis
High aldosterone and low renin
Responds to dexamethasone

23
Q

Primary adrenal insufficiency treatment

A

Glucocorticoid replacemen: Hydrocortisone, prednisone, prednisolone
Mineralocorticoid replacement: fludrocortisone acetate (Na sparing)

24
Q

Phenoxybenzamine

A

Long acting non-selective a-blocker for treating pheochromocytoma
Give b-blocker (metoprolol) after to avoid unopposed alpha and paradoxical worsening of HTN

25
Q

Primary Aldosteronism findings

A

Most are hypertensive, does not suppress w/ Na loading

26
Q

MEN2a symptoms

A

Parathyroid Hperplasia
Medullary Thyroid CA
Pheochromocytoma
(Gain of function RET)

27
Q

Dexamethasone suppression test

A

Cushing’s disease: suppressed cortisol, normal ACTH
Ectopic: unsuppressed cortisol, high ACTH
Primary: unsuppressed cortisol, low ACTH

28
Q

Inherited steroidogenesis (Addisons) causes

A

Congenital Adrenal Hyperplasia: Deficient aldosterone (salt wasting), deficient cortisol, excessive androgens,

29
Q

Steroid treatment of Addisons dz

A

Glucocorticoid (hydrocortisone) + Mineralocorticoid (Fludrocortisone)

30
Q

Steroid treatment of Congenital adrenal hyperplasia

A

Hydrocortisone + Fludrocortisone

31
Q

Adrenal incidentaloma next step

A

Test for Pheochromocytoma! look at Metanephrines

32
Q

VHL type 2

A

AD, 20% get pheochromocytoma (only nor-epi here)

Hemangiomas, hyperthyroid, adenomas, etc

33
Q

What do you do with a pt with suspected primary aldosteronism

A

Thin section CT scan of adrenals to screen for adrenal carcinoma (although rare)

34
Q

Cushings DISEASE

A

ACTH-secreting Pituitary Adenoma

35
Q

Metabolic effects of glucocorticoids

A

Decreased protein uptake, synth. (myopathy, wasting)
Lipolysis, lipogenesis, fat deposition, change in dist.
Gluconeogenesis, glucose output, synthesis, hyper-gly

36
Q

Ketaconazole

A

Blocks fungal and mammalian CYP450 enzymes
Inhibits steroid hormone synth and fungal ergosterol
Oral/topical, can cause hepatic dysfunction and drug-drug interactions w/CYP

37
Q

Lab findings in primary adrenal insufficency

A

Low serum Na, High serum K
Low 8AM plasma cortisol w/ high plasma ACTH
Serum Abs to 21-hydroxylase, elevated 17-hydroxyprogesterone!! (required for dx)

38
Q

Liddle Syndrome

A

Decreased degradation of Na channels, AD
HTN, Hypokalemia, Metabolic Alkalosis in children
Low aldosterone and low renin
Tx w/ K-sparing diuretics

39
Q

What catalyzes the switch between active and inert steroids?

A

Activator: 11 B-HSD1 (keto-reductase)
Inactivator: 11 B-HSD2 (dehydrogenase)

40
Q

Mifepristone

A

Glucocorticoid and progesterone antagonist
For medical abortions (rarely cushings)
Oral admin, can cause vaginal bleeding in women, abdominal pain, GI upset, HA

41
Q

Spironolactone

A

Mineralocorticoid antagonist, weak androgen antagonist
Tx aldosteronism, hypo-K from diuresis, post-MI infarct
Slow onset and offset, lasts 2-4 days
Can cause Hyper-K, gyno

42
Q

Intermediate acting adrenal corticosteroid drugs (12-36 hr)

A

Prednisone
Prednisolone
Methylprednisolone
Triamcinolone

43
Q

Fludrocortisone

A

Mineralocorticoid agonist
Tx adrenal insufficiency (Addisons)
Long duration of action
Toxicities: salt and fluid retention, CHF, sign and sx of glucocorticoid excess

44
Q

Metyrapone

A

Mineralocorticoid agonist, used to diagnose adrenal insufficiency and rarely to treat cushing’s

ENRP (4 decks)

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