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15 Cards in this Set
- Front
- Back
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are random serum cortisol levels helpful?
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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 |
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AI
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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) |
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what causes hyperpigmentation
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incr ACTH
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how Dx AI?
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Cortrosyn (=ACTH) stimulation test
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Sx:
low cort hypotension Dx? |
Primary AI (secondary AI has nl ALDO, so no hypotension)
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low cort
nl BP Dx? |
Secondary AI
(nl ALDO, so nl BP --vs. Primary AI--low ALDO, so low BP) |
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Cushing's
et? |
1. MCC=pit tumor (70%)
2. ectopic ACTH (15%) -sm cell lung cancer 3. adrenal tumor (15%) |
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cushing's disease
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pituitary Cushing's
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Hyperaldosteronism
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Primary:
1. *MCC=adrenal hyperplasia (70%) 2. Adrenal adenoma=Conn's (30%) **LOW renin Secondary: -volume depletion -CHF -cirrhosis -nephrotic syndrome *HIGH renin |
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primary ALDO:
-screening? -confirmation? |
-screening:
"positive" screen is ALDO:renin > 20 -confirmation: saline supp test |
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pheochromocytoma
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-adrenal medulla tumor
==>secretes catecholamiens Sx (Goljan): 1. labile HTN (hard to control) 2. disphoresis (sweating) 3. papitations (anxious) |
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Sx:
-low FSH, LH, ACTH, TH, GH -high PRL Dx? |
hypothalamic lesion or compression of pit stalk
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how do pt with hypothalamic lesion present?
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all ant pit hormones are low, except PRL (incr PRL)
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how do pt w/compression of pit stalk present?
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all ant pit hormones are low, except PRL (incr PRL)
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all pit hormones are low
Dx? |
hypopituitarism
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