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7 Cards in this Set
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Clinical presentation of primary aldosteronism:
How to exclude extra-renal loss of K+: Best screening test: |
asymptomatic HTN and unprovoked/easily provoked hypokalemia
check urinary K+; >30 + hypokalemia = renal K+ losing state plasma aldosterone/renin - calculate PA/PRA ratio (>20 = primary aldosteronism, <10 in secondary) |
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How do you confirm the diagnosis of primary aldosteronism?
What is the major differential dx in primary aldosteronism? Causes of secondary aldosteronism: Other mineralocorticoid causes? |
saline loading fails to suppress aldosterone production
adenoma or bilat adrenal hyperplasia HTN, low K+, high aldosterone, increased renin activity DOC-producing tumors, CAH, Cushing's |
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What enzyme can be deficient because of licorice or chewing tobacco use?
Surgical and medical tx for primary aldosteronism? What can you use to treat glucocorticoid-remediable hyperaldosteronism? |
11-OH-steroid-dehydrogenase in DCT's - converts OH-cortisone to cortisone
adrenalectomy medical therapy - dietary salt restriction, K+ sparing diuretics (spironolactone), men can use amiloride or triamterene dexamethasone |
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Most common cause of CAH?
best tx for late-onset CAH? When is screening for aldosteronoma appropriate? Adrenal tumor with characteristic fat-density imaging on CT: |
21-hydroxylase - 17-OHP accumulates
low-dose glucocorticoid --> lowers ACTH, androgens HTN w/ or w/o hypoK+ adrenal myelolipoma |
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Best CT discriminating factor between malignant/benign tumors?
Needle aspiration for what tumor is hazardous? Only place for needle aspiration in adrenal mass diagnosis? |
size - most are <4 cm, 35% >6 cm
phemochromocytoma clinical setting suggestive of mets |
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Most common cause of adrenal insufficiency:
Most common infectious cause of primary adrenal insufficiency: Other causes of primary AI: 3 causes of secondary AI: |
Addison's - autoimmune destruction
AIDS hemorrhage/infarction, mets cancer, AI/CNS demyelination, amyoid, sarcoid pituitary atrophy from exogenous use of glucocorticoid, hypopituitarism, isolated ACTH (post partum) |
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Gold standard of diagnosis of AI:
If ACTH stimulation is abnormal, then what? |
ACTH stimulation test
check plasma ACTH levels to determine primary vs secondary disease |
