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65 Cards in this Set
- Front
- Back
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What is Cushing's syndrome in general?
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A condition of increased cortisol production; could be caused by a variety of things.
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What are 4 things that cause Cushing's syndrome?
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1. Cushing's disease - primary pituitary adenoma
2. Primary ADRENAL synthesis 3. Ectopic ACTH production 4. Iatrogenic - steroids |
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What would ACTH levels be in
-Cushing's disease -Primary adrenal adenoma -Ectopic Small cell lung cancer -Iatrogenic |
Cushing's disease - high ACTH
Primary adrenal - low ACTH Lung carcinoma - High acth Iatrogenic - low ACTH |
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What symptoms does Cushing's syndrome cause? Any difference in symptoms caused by different etiologies?
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Nope
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What metabolic changes does Cushing's cause?
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Hypertension
Hyperglycemia |
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What Body changes does Cushing's cause?
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-Weight gain
-Moon facies -Buffalo hump -Truncal obesity -Skin thin/Striae -Osteoporosis |
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What physiologic changes does Cushing's cause?
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Amenorrhea
Immunosuppression |
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How do you test for the etiology of Cushing's syndrome?
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Dexamethasone suppression testing
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What does the Dexameth supp test check for?
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Whether low or high doses of Dexamethasone can inhibit pituitary release of ACTH, and thus reduce cortisol.
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What will ACTH and Cortisol levels after a low dose of Dexameth be in health?
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LOWER - both
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What will ACTH/cortisol levels be after low dose or high dose in an ACTH-secreting tumor?
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No inhibition of ACTH release by low dose, so Cortisol increases
High dose inhibits, so cortisol then decreases |
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What will ACTH/cortisol levels be after low/high dose Dexameth in a Cortisol-secreting primary adrenal tumor?
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Never inhibited - Cortisol is always high
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2 forms of HyperALDOSTERONISM:
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-Primary
-Secondary |
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What is primary hyperaldosteronism?
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Conn's syndrome
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What is Conn's syndrome caused by?
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An ALDOSTERONE SECRETING TUMOR
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What are the 4 effects on blood levels that Conn's syndrome will cause as a result of hyperaldosterone secretion?
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1. Hypertension
2. Hypokalemia 3. Metabolic alkalosis 4. LOW plasma renin |
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What is Conn's syndrome treated with?
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Spironolactone
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What is 2ndary Hyperaldosteronism caused by?
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HIGH RENIN - things that cause it to be elevated
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What causes the kidneys to oversecrete renin?
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Perception of low intravasc volume
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5 causes of low intravascular volume, or at least the perception of it:
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-CHF
-Cirrhosis -Nephrotic syndrome -Chronic renal failure -Renal artery stenosis |
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So the main difference between primary Conn's hyperaldo and 2ndary hyperaldo is:
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Conn's - low renin
2ndary - high renin |
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And what does too much aldo cause?
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-Hypertension
-Hypokalemia -Alkalosis |
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What is deficient in ADDISON'S disease?
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All Adrenal Hormones are Absent in Addison's!
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What is Addison's disease caused by?
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Adrenal atrophy - a primary intrinsic adrenal problem
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How is Primary adrenal atrophy differentiated from 2ndary insufficiency?
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ACTH levels
-High in primary Addison's -Low in 2ndary (pituitary fails to secrete) |
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What is the manifestation of high ACTH?
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Skin bronzing due to hypersecretion of MSH from POMC
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What is the main problem in Addison's disease, other than skin being bronzed?
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Hypotension - due to lack of sodium - hyponatremic volume contraction
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what is the most common adrenal medulla tumor in
adults children |
Adults - pheo
Children - neuroblastoma |
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From what cell type is a pheochromocytoma derived?
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Neural crest Chromaffin cells
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What is the HALLMARK FINDING in Pheochromo?
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Headaches, hypertension, URINE VMA HIGH
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3 SYNDROMES associated with Pheos:
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-Neurofibromatosis
-MENII (medullary type) -MEN III |
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Where can neuroblastomas be found in children?
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Adrenal medulla, but ALSO ANYWHERE ALONG THE SYMPATHETIC CHAIN!
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What is the HALLMARK finding in Neuroblastoma?
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Urine HVA!!! Less likely to have hypertension
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So what is the elevated urine metabolite in
-Pheo -Neuroblastoma |
Pheo = VMA
Neuroblastoma = HVA |
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Postpartum hypopituitarism
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Sheehan's syndrome
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What is Sheehan's caused by?
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Hyperplasia of the pituitary, then severe bleeding and hypoperfusion during delivery because it outgrew its blood supply.
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What is the result of the pituitary exceeding its blood supply?
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infarction
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Is Sheehan's an acute situation?
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No, it just causes symptoms of Postpartum hypopituitarism?
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What ARE 4 symptoms of Postpartum hypopituitarism?
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-Fatigue
-Loss of pubic and axillary hair -Anorexia -Failure to lactate to breastfeed |
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So what can Sheehan's really put a woman in?
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A FLAP
fatigue, loss of hair, anorexia, failure to breastfeed |
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Tumor secreting NE, EPI and DA:
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Pheochromocytoma
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Urine elevated substance in Pheo:
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VMA - Vice President, VMA, Pheo
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Pheos are associated with:
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MEN 2/3
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Main drug for treatment of Pheo:
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Phenoxybenzamine
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What is Phenoxybenzamine?
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NONSELECTIVE, IRREVERSIBLE a-blocker
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Nature of symptoms seen in Pheos:
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Episodic hyperSNS
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5 symptoms of Pheo's
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Pheos cause the P's
-Pressure (bp) -Pain (headaches) -Perspiration -Palpitations (tachy) -Pallor |
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What is the 6 rule of 10's?
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10% malignant
10% bilateral 10% familial 10% kids 10% calcify 10% extradrenal |
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And the main thing to remember about the P symptoms in Pheo:
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EPISODIC - they come and go in spells
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How many MENs are there?
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3 - type I, II, III
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MEN type I:
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Wermer's syndrome
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MEN type II:
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Sipple's syndrome
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MEN type III:
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Formerly MEN IIB
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What is the inheritance of all MEN syndromes?
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Autosomal dominant
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What gene mutation is seen in MEN I?
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Ch' 11 - tumor suppressor inactivated
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What gene mutation is seen in MEN II?
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Ch'10 Ret gene mutation - protooncogene activated
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What are the 3 kinds of tumors seen in MEN I/Wermer's syndrome?
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PAN PARA PIT
-Pancreas -Parathyroid -Pituitary |
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What does the Pancreas tumor cause?
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Zollinger-ellison, insulinomas, and VIPomas
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What is the most common pituitary tumor to be seen in MEN I?
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Prolactinoma
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What are the 2 common presenting symptoms then in MEN I?
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-Kidney stones
-Stomach ulcers |
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Why kidney stones in MEN I?
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PTH oversecretion - hypercalcemia
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Why the gastric ulcers in MEN I?
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The VIPomas and ZE-syndrome - hypersecretion of gastrin
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Treatment for zollinger ellison?
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PPI
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What are the 3 tumors seen in MEN II?
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-Medullary thyroid carcinoma
-Pheochromocytoma -Parathyroid hyperplasia MEDULLARY |
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What sets apart MEN IIB aka MEN III from MEN IIa?
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Oral and Intestinal Ganglioneuromatosis
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