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15 Cards in this Set

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are random serum cortisol levels helpful?
No, b/c:

-pulsatile secretion==>highest cort level at 8am
-wide range of nl values (4-25)
-sensitive to stress
-falsely lwoered in low protein states
AI
Primary AI:
*destruction of entire adrenal cortex:
~*MCC=autoimm destruction
~adrenal hemorrhage
~infxn: TB

*low cort==>incr ACTH==>hyperpigmented
*low ALDO==>high renin

Secondary AI:
*destruction of pit
~*MCC=exogenous steroid/corticosteroid Tx
~pit dz

*destruction of pit==>decr ACTH==>adrenal atrophy
-no hyperpigmentation b/c ACTH is not incr
-ALDO is nl (not affected by adrenal hormones)
what causes hyperpigmentation
incr ACTH
how Dx AI?
Cortrosyn (=ACTH) stimulation test
Sx:
low cort
hypotension

Dx?
Primary AI (secondary AI has nl ALDO, so no hypotension)
low cort
nl BP

Dx?
Secondary AI

(nl ALDO, so nl BP
--vs. Primary AI--low ALDO, so low BP)
Cushing's
et?
1. MCC=pit tumor (70%)
2. ectopic ACTH (15%)
-sm cell lung cancer
3. adrenal tumor (15%)
cushing's disease
pituitary Cushing's
Hyperaldosteronism
Primary:
1. *MCC=adrenal hyperplasia (70%)
2. Adrenal adenoma=Conn's (30%)

**LOW renin

Secondary:
-volume depletion
-CHF
-cirrhosis
-nephrotic syndrome

*HIGH renin
primary ALDO:
-screening?
-confirmation?
-screening:
"positive" screen is ALDO:renin > 20

-confirmation: saline supp test
pheochromocytoma
-adrenal medulla tumor
==>secretes catecholamiens

Sx (Goljan):
1. labile HTN (hard to control)
2. disphoresis (sweating)
3. papitations (anxious)
Sx:
-low FSH, LH, ACTH, TH, GH
-high PRL

Dx?
hypothalamic lesion or compression of pit stalk
how do pt with hypothalamic lesion present?
all ant pit hormones are low, except PRL (incr PRL)
how do pt w/compression of pit stalk present?
all ant pit hormones are low, except PRL (incr PRL)
all pit hormones are low

Dx?
hypopituitarism