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19 Cards in this Set
- Front
- Back
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what is the most common cause of cushing SYNDROME
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iatrogenic (drug use that stimulates too much cortisol)
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what are the ACTH independent causes of cushing syndrome?
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adrenal tumors (dependent exampes are ectopic ACTH tumors or pit tumors)
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how can you tell the difference between ACTH dependent causes and ACTH independent causes with labs ONCE you have already dx cushing syndrome?
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ACTH > 20 pg/dl = dependent, < 5 rules out dependent causes (the reason you would do this after dx of cushing is because ACTH measurements are not useful unless you already know they have cushing's... isolated ACTH or cortisol levels are not helpful to diagnose the syndrome)
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how do you dx cushing syndrome
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same as cushing disease: 24 hr urine free cortisol, dexamethasone suppression tests, and salivary insulin tests at 11pm and midnight
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how can you tell if this is an pit adenoma or an ectopic ACTH tumor?
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ectopic ATCH production will not respond to dexamethasone or CRH, but pit adenomas will (just at higher doses than the normal person)
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what do these clinical manifestations indicate:
Fatigue and weakness (95%) Anorexia (90%) Weight loss (100%) – gradual failure to thrive Impaired mentation (75%) Hypotension Hyponaremia +/- hyperkalemia Decrease Na not because of aldosterone but cortisol is needed to regulate Hypoglycemia |
adrenal insufficiency
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what disease is associated with other endocrine disorders (poly endocrine syndrome)
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addison's disease (primary adrenal insufficiency)
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these unique features are associated with what disase: salt craving, hyperpigmentation, hyperkalemia
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addison's disease
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what are examples of secondary adrenal insufficiency
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stopping steroids abruptly will cause insufficiency because they haven't been producing hormones on their own, hypothalamus tumors or pit tumors or hypophysitis
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you give a patient who you suspect of having SECONDARY adrenal insufficiency ACTH, if they do have adrenal insufficiecny, what will you see
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giving them ACTH is what the body wants (since its lacking it), so the cortisol levels should jump up to > 20ug/dl.
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what is the difference between a primary and secondary hyperaldosterone pt?
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the screen to determine if we think they have primary aldosterone is to check the aldosterone to serum renin activity. 20:1 is primary hyperaldosteronism. secondary causes will have high aldosterone and high renin.
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how can you test for hyperaldosteronism?
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salt load, aldosterone should go down in a normal person.
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a patient comes in complain of dizziness, palpitations, anxiety, and their family care doctor recentaly started them on anti-HTN drugs, but they are now in the endocrinologists office for help with these "spells"
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pheochromocytoma
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testing a patient for pheochromocytoma
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clonidine suppression test (giving them catecholamines should suppress the level of catecholamines
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other tests for pheochromocytoma
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test the level of the catecholamines
24 hour metanephrines, catecholamines and/or VMA Plasma catecholamine Serum metanephrines |
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what scan is specific for pheochromocytomas?
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MRI
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what must you do before taking a pheochromocytom pt into surgery
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give them an alpha blocker (so they are not hypertensive after the surgery)
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if you have a pt with labs > 700 DHEA, what are you suspecting is the cause of their precocious puberty
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adrenal tumor
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if the DHEA levels are > 200, what is on your differential for this female patient?
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ovarian tumor
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