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37 Cards in this Set
- Front
- Back
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what are 4 classes of hormones that the adrenal glands produce?
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mineralcortocoids
glucocorticoids adrogen catcholamines |
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what are some sx of cushings dz?
what is elecated? |
buffalo hump, thin arms and legs, immunocompromised, central body fat, abdominal striae, HTN, osteoporosis, diabetes
ACTH |
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what is the most common cause of cushings dz?
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iatorgenic
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what are 2 example of ACTH dependent cushings?
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pituitary tumor that causes the production of to much ACTH and ectopic tumor (paraendorcine) that also produces to much ACTH
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what are the majority of tumor that secrete ACTH ectopicall?
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SCC
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what is an example of ACTH independent cushings?
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tumor in the adrenal cortex that causes excess production of mineral and glucocorticoids. most of these are benign
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if you measure ACTH to be:
<5 then... >20 then... |
ACTH independent
ACTH dependent |
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what 2 test are done for ACTH dependent cushings?
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dexamethasone suppression test and CRH stimulation test
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People with cushings dz will respond to CRH stimulation test but if it is due to ectopic production then it will not.
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blank
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Only after you prove that the cushings you have is a ACTH dependent, then should you do imaging (MRI)
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with someone with an ectopic tumor that is producing the ACTH, you need to start them on ACTH before the surgery so the levels do no drop.
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what are some signs and sx of adrenal insufficency?
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fatigue, Wt loss, hypotension, anorexia
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what is the most common infectious cause of adrenal insufficency?
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TB
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what is the most common AI dz that causes adrenal insufficency?
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addisons dz
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what are some features of addisons dz?
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dark pigmentation, salt craving, hyperkalemia
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what is the most common cause of secondary adrenal insufficency?
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steroid withdraw (must wein off)
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someone with secondary/tertiary adrenal insufficency will still produce what hormone?
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aldosterone. this means they typically do not have hyperkalemia
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what test do you run to test for primary adrenal insufficency?
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cosyntropin (ACTH) stimulation test
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what is the tx for adrenal insufficency?
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gluco and mineralcortoicoids
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24 year old man presents with fatigue, weight loss and dizziness. His glucoses are normal/low. Sodium low and potassium slightly high. You suspect adrenal insufficiency. Which test would be most appropriate?
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cosyntropin (ACTH) stimulation test
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if you find an incidental adrenoma, what are 2 tumor types you should screen for?
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pheochromocytoma and cushings tumor.
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what tumor should always be ruled out prior to surgery?
why? |
pheo.
may lead to HTN crisis |
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if an incidental adrenoma is found, upon what size should it be considered removed?
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>4cm
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66 year old woman is hospitalized for abdominal pain. A C.T. scan reveals a 3 cm solid mass in the right adrenal gland. She is obese and has diabetes and hypertension. What do you recommend?
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get lab studies to see what it is
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what are some clinical manifestation of hyperaldosteronism?
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hypokalemia and HTN
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what are the aldosterone and renin levels for primary hyperaldosteronism?
secondary? |
primary- aldosterone is high and renin is low
secondary- aldosterone is high and renin is high. |
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what is the tx for hyperaldosteronism due to tumor?
due to adrenal hyperplasia? |
remove
medicate |
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what are the sx of a pheochromocytoma?
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spells of tachycardia, diaphoesis, headaches, and chest pain.
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what hormones are made via a pheochromocytoma?
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NE and epi
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what is the test you should run if you expect a pheochromocytoma?
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24 hr metanephrines
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what should a pt with a pheochromocytoma be tx with prior to surgery?
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alpha blockers
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what is a common cause of androgen excess?
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congential adrenal hyperplasia (lack an enzyme so to much of certain steroids get produced)
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what are some sx of congenital adrenal hyperplasia?
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ambigious genitalia
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what is the principle androgen secreted by the adrenals?
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DHEA
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DHEA-S >700 suggests...
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adrenal tumor
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what is the principle androgen from the gonads?
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test
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testosterone of >200 in a female suggests what?
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ovarian tumor
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