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28 Cards in this Set
- Front
- Back
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What are the 3 basic things you want to know about an Adrenal Incidentalinoma?
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1) Functional or Not 2) Unilateral or Bilateral 3) Malignant or Not |
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If you suspect a functioning Adrenal Incidentalinoma, what 3 disorders are you primarily screending for? |
1) Conns Syndrome 2) Pheocromocytoma 3) Cushings |
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Other than HTN, what other lab abnormality would a patient with Conns Syndrome present with? What precentage of Pts have this?
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50% of Pts will have Hypokalemia |
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What are the common Sympotoms of Cushings Syndrome? |
1) Proximal Muscle Weakness 2) Buffalo Hump 3) Central Obesity |
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What disorders are commonly associated with Cushings Syndrome?
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HTN Diabetes OSA Osteoporosis Obesity |
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What are the screening options for Cushings?
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1) Low (1mg) dose Dexamethasone 2) Late night Salivary Cortisol level 3) 24hr Urinary Cortisol Level |
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If you get a positive screening test for cushings, what is your next step?
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Get another Screening test (usually one of the other ones).
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If multiple screening tests (usually 2) are + for Cushings, what is the confirmatory test?
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Check ACTH
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What are the Cut off values for Depenent and Independent ACTH levels. Where are the locations of the tumors for dependent and independent?
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Dependent: >20, Pituitary or Ectopic production Independent: <5, Adrenal Production of Cortiosol |
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You have mulitple + Screening tests for Cushings, with an ACTH of 3. What is your top Ddx, where is the cortisol originating? What is the next best step? |
1) Independent Cushing Syndrome 2) Adrenal gland, Adrenal Tumor 3) Adrenal CT or MRI |
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In a Patient who just confirmed Dependent Cushings based on ACTH level of 30, what is the next best step? What does this differentiate?
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High Dose Dexamethasone Supression test Differentiates Pituitary from Ectopic Production -- + Stim test/Will Supress Pituitary -- (-) Stim test/ Will Not supress |
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A pt has an ACTH level of 42, a High dose Dex test is Positive! What is the Next best Step? |
Pituitary MRI to confirm Pituitary Adenoma
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A pt has an ACTH level of 50, High dose Dex is Neg. What is the next best step?
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Chest/Abd MRI to Confirm Ectopic Producing Adenoma.
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What are the common presenting symptoms of Pheocromocytoma?
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1) Episodic HTN 2) Triad: HA/Diapharesis/Palpitations |
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What is the difference between Pheocromocytoma and Parganglionoma?
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Pheocromocytoma: Catacholamine Secreting tumor in the ADRENAL gland Paraganglionoma: Catacholamine Secreting Tumor OUTSIDE the adrenal gland |
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What is the appropriate screening test for Pheo?
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Urine and Serum Metanephrines |
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Which screening test for Pheo is prone to high False positive rates? |
Serum Metanephrines Don't ever pick serum Catacholamines, Super high false +, Basically useless |
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Whats the Confirmatory test for Pheo?
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Screening test with clinical/Radiographic evidence is Confirmatory. |
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What common Medication will increase the rate of False + Screening testing in patients supsected of Pheo?
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TCA's , Pts need to be tapered off over a 2wk period. Other meds: Pseudofed, Caffine, Tobacco/ETOH |
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What evidence will lead you to suspect Conns Syndrome? |
Incidentalinoma and HTN Pt with Early onset HTN <35yrs Fhx Hypokalemia |
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What is the screening test for Conns Syndrome, what are the cutoff levels?
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Renin/Aldosterone Levels 1) Aldo level >15 2) Ratio Aldo/Renin >20 |
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What Meds increase rates of False positives in patients suspected of Conns Syndrome?
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ACEI, ARBS, Must be off for 2wks |
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What meds do not effect results of Renin/Aldo levels?
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1) Nondihydropiradine CCB (dilt, Verapamil) 2) Hydralazine 3) Alpha Blockers |
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A patient has a Aldo/Renin Ratio of 33, what is the next best step?
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Confirmatory Saline Suppresion Test (Normally, Na load should supress Aldo levels)
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What characteristics of Adrenal tumors/Incidentalinomas would suggest surgery? Malignancy vs Benign?
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1) Size --4-6cm = Surgery --<4cm = Benign 2) Houndsfield Units -->20 = Surgery -- <10 = Benign 3) Washout usually 10min -->50% are typically Benign |
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At patient has a confirmatory saline supression test that is positive. What is the next step?
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3 Phase CT, Ruling out Other Masses.
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A patient suspected of Conns syndrome from a + Screening test, + Na supression and 3 phase CT that was negative for Masses. What is the next best step.
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Venous Sampling, to assess lateralization. That way we know which adrenal gland its coming from. Typically done in Patients >40yrs. Younger patients will usually have a mass that is secreting.
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A patient suspected of Conns syndrome from a + Screening test, + Na supression and 3 phase CT showing 3cm Mass on the right. What is the next best step.
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Venous sampling. Regardless of what CT shows. You can have a left secreting adrenal gland (the actual problem) with a benign incidentalinoma on the right.
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