Adrenal Disease I

Front 1

What should make you think 'pheochromocytoma'?

Back 1

1. Resistant HTN

2. Diaphroesis

3. Headache

4. No family hx of HTN; lean, young patients

Front 2

What are the precursors of steroids?

Back 2

1. 17-OH progesterone

2. DHEA

Front 3

Where are steroids produced?

Back 3

1. Adrenal glands

2. Gonadal tissue

Front 4

What is one of the MC enzyme deficiencies in steroid synthesis? What step does it catalyze

Back 4

1. 21-a-hydroxylase--- 17-OH progesterone to 11-deoxycortisol

Front 5

What is the MCC of congenital adrenal hyperplasia?

Back 5

1. 21-hydroxylase deficiency

Front 6

What are the ssx of congenital adrenal hyperplasia?

Back 6

1. Ambiguous genitalia in infant girls

2. Late-onset CAH in adult women=hirsutism

Front 7

How is congenital adrenal hyperplasia recognized in infant boys?

Back 7

1. Must be screened for 17-OH progesterone

2. Unrecognizable without blood test

Front 8

Why is end organ hormone testing important?

Back 8

1. Secretion may be normal--- normal is subjective

2. Test end organ in order to dx pituitary disorder

Front 9

How are ACTH and cortisol linked?

Back 9

1. If ACTH is normal and cortisol is low, ACTH is inappropriately normal

2. Check for function relationships

Front 10

High CBG leads to what? Low CBG?

Back 10

1. High CBG=high cortisol total

2. Low CBG=low cortisol total

Front 11

What is the effect of estrogen on CBG?

Back 11

1. Increases CBG

Front 12

What is the effect of malnourishment on CBG?

Back 12

1. Patient may have low CBG but normal free cortisol

Front 13

How do you measure free cortisol?

Back 13

1. 24 hour urine

2. NOT SERUM

Front 14

What is the effect of exogenous steroids on cortisol?

Back 14

1. Can alter serum and urine cortisol levels

2. If given >4 weeks, consider weaning

3. ACTH suppressed as well

Front 15

What can cause acute adrenal insufficiency?

Back 15

1. Adrenal hemorrhage or infarction

2. Pituitary apoplexy

Front 16

What is pituitary apoplexy? What causes it?

Back 16

1. Compromise of pituitary function

2. Hemorrhage, neoplasm

Front 17

What are the ssx of pituitary apoplexy?

Back 17

1. Abrupt blurring of vision with tunnel vision

2. Decreased peripheral vision

3. Bitemporal hemianopsia

Front 18

What is the urgency of pituitary apoplexy?

Back 18

1. EMERGENCY

Front 19

What disorders can follow pituitary apoplexy?

Back 19

1. Secondary adrenal insufficiency

2. Secondary hypothyroidism

Front 20

What are the ssx of primary adrenal insufficiency?

Back 20

1. N/V

2. Weakness, fatigue

3. Confusion/coma

4. Hyperpigmentaiton

5. Electrolyte imbalance

Front 21

What is an adrenal crisis?

Back 21

1. Low mineralocorticoid leads to hypotension, creates crisis

Front 22

What type of adrenal insufficiency most often causes an adrenal crisis?

Back 22

1. Primary

Front 23

How do you avoid an adrenal crisis precipitated by surgery?

Back 23

1. Steroids

Front 24

What are the lab results for primary adrenal insufficiency?

Back 24

1. Hyponatremia

2. Hyperkalemia

3. Hypotension

4. Low glucose

5. Elevated BUN/Cr

Front 25

What are the lab results for secondary adrenal insufficiency?

Back 25

1. Hyponatremia

2. Normal K

3. Low ACTH

4. Low cortisol

Front 26

How do you dx adrenal insufficiency?

Back 26

1. Cosyntropin stimulation test

2. Check cortisol 30 and 60 minutes after the injection

3. Goal is 20 mcg/dL or greater

Front 27

When should tx for adrenal insufficiency be initiated?

Back 27

1. ASAP

Front 28

What should you do in the case of suspected AI and an abnormal cosyntropin stimulation test?

Back 28

1. Check ACTH

2. Check plasma renin

3. Check steroid autoantibodies

Front 29

What are the MCC of AI?

Back 29

1. Autoimmune/idiopathic

2. TB

3. Vascular, infectious, AIDS

Front 30

How do you tx AI?

Back 30

1. Hydrocrotisone

2. DO NOT USE DEXAMETHASONE AND PREDNISOLONE

Front 31

What should be monitored during tx of AI?

Back 31

1. Weight and BP

2. Electrolytes

3. ACTH

4. Urine cortisol

Front 32

What is the dosing of hydrocortisone with an acute illness? What types of illnesses should it be used for?

Back 32

1. Double dose

2. Emesis, trauma, surgery

Front 33

What is used for aldosterone replacement in primary AI?

Back 33

1. Fludrocortisone

Front 34

What should be monitored in fludrocortisone use?

Back 34

1. 'Lytes

2. Renin

Front 35

What is a typical hx for a patient with secondary AI?

Back 35

1. Long-term steroid use

2. Recent change in pharmacy

Front 36

What are the common presenting ssx of secondary AI?

Back 36

1. Cough

2. Fever

3. Lung infiltrate

Front 37

What are the MCC of secondary AI?

Back 37

1. Steroid use

2. Tumor, infection, radiation, surgery

Front 38

What imaging can be used to dx AI (1o and 2o)?

Back 38

1. CT of adrenals--- small glands is +

2. MRI of brain--- secondary