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16 Cards in this Set
- Front
- Back
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What are the two different types of adrenal insufficiency?
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secondary AI: pituitary ACTH secretion is inadequate… Primary AI: damaged adrenal
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Which, primary or secondary adrenal insufficiency would be more likely to affect all hormones in the adrenal cortex?
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Which, primary or secondary adrenal insufficiency would be more likely to affect all hormones in the adrenal cortex? Primary, since ACTH suppression will not effect the ZG
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What are the finding in AI with respect to GI, weight, BP, Na, contractility, Mineralocorticoids, and K?
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What are the finding in AI with respect to GI (nausea, vomiting or diarrhea, weight (loss with anorexia), lowered BP, lowered Na, Mineralocorticoids if affected --> increased K, lowered contractility
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What comorbity is seen with primary AI?
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What comorbity is seen with AI? Other autoimmune dz, e.g, hashimoto's, thyroid, pacreatic islets, ovary, gastric mucosa
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A patient presents with bilateral destruction of the adrenal, what might you suspect?
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A patient presents with bilateral destruction of the adrenal, what might you suspect? TB, where the infection was transmitted from the lung or the bowel
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Besides autoimmune and TB causes of adrenal insufficiency, what are 4 other causes of AI?
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HIV, Infiltrative processes (amyloidosis, hemochromatosis), Hemorrhage (adrenal apoplexy, people receiving anticoagulation Rx, people infected with meningococcal sepsis), metastatic carcinoma
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Which type of of AI do you see hyperpigmentation? Primary or secondary?
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Which type of of AI do you see hyperpigmentation? Primary or secondary? Primary --> increased CRH --> ACTH also produces MSH
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What is secondary AI?
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destruction of hypothalamus or pituitary
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How do you determine the type of AI (primary or secondary)?
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Give ACTH --> if increase in cortisol in a few days=secondary, if no increase=primary… ALTERNATIVELY: Measure ACTH: if high=primary, if low=secondary
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Why do synthetic GC have a more potent effect?
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they are not subject to the same enzymatic/metabolic effects of endogenous GC
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Which is the most potent GC?
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Dex
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Which is the most potent exogenous MC? whichis the most potent endogenous MC?
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Which is the most potent MC? 9a fluorocortisol (which also has a 10x effect on GC.
Endogenous: Aldosterone |
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Which is the strongest endogenous MC?
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Which is the strongest endogenous MC? Aldosterone
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when can you use ACTH level to check for GC Rx overdose? Primary or secondary adrenal insufficiency
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when can you use ACTH level to check for GC Rx overdose? Primary… it will drop… secondary will not demonstrate overdose since it will remain absent
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Why are synthetic GC preferred over endogenous for Rx of adrenal insufficiency?
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Why are synthetic GC preferred over endogenous for Rx of adrenal insufficiency? They are more potent plus the have less MC effect.
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What are three problems with GC Rx?
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What are three problems with GC Rx? 1) drug induced Cushings… 2) Upon withdrawl --> worsening of symptoms even though the dz is not present… 3) adrenal atrophy upon withdrawl (which can be managed by giving the drug less often)
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