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53 Cards in this Set
- Front
- Back
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patient with high T4 what test to you order next and why
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urine test to rule out pheocytoma
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if catecholamines are high what test should be ordered
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clonidine supression
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if clonidine doesn't not supress catecholamine what is the problem
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pheochromocytoma
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what hormones comes out first in stress
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ACTH
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what is the second hormone that peaks out in stressful situations
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cortisol
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what happens with when hormone replacement is stopped
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the ACTH still spikes but the cortisol remain flat
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what do you do to treat someone who is adrenal insufficient
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give them exogenous cortisol
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when should you suspect adrenal insufficiency
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exogenous steroids
contusion/malaise dehydration, nausea, vomitting fever tachycardia, hypotension hyponatremia, hyperkalemia Elevated BUN |
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when in doubt what should you do about steriod insufficiency
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steriod prep
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what is dose of steroid prep
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200-300mg of IV hydrocortisone in divided doses
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what should you always do after giving steriods
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taper
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anyone on steroids should also be on what
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bisphophates for bones
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addisons disease
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cortisol deficiency
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cushings syndrome
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cortisol excess
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cushings patient can develop what intolerance
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glucose
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what are the funny fat deposits of cushings
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buffalo hump or moon facies
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what are some other clinical signs of cushings
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easy bruisability
violaceous striae around iliac crest HTN and osteoporosis |
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cushings is a secondary cause of what
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hypertension
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what are some other secondary causes of hypertension
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pheochromocytoma
primary aldo |
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what are cortisol levels with cushings
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high in the morning and low in the evening
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what is the function of cortisol while you are sleeping
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maintains your blood sugar
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what is the effect of increased muscle mass on insulin sensitivity
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increases sensitivity
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what glucose tests will you get if you suspect cushings
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a fasting and a 4-8 pm cortisol level
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cushings disease=
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pituitary tumor
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what is in differential of cushings syndrome
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pituitary tumor
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what is treatment now for cushings disease
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transphenoidal hypohysectomy
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what is treatment for ectopic tumors
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treat underlying disease
inhibitors of steroid synthesis |
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what are some examples of steroid syn inhibitors
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metyrapone, aminogluthethimide or adrenolytic agent
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what is treatment for adrenal neoplasm
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removal then use of supplemental exogenous steroids for indefinite period of time
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what is suppressive agent for suspected cushings
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low dose dexamethasone
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what should happen to cortisol levels if everything is normal and you give 2mg dex
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it should suppress
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what if you don't suppress with low dose dex
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cushings syndrome
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what is diagnosis if you can supress with high dose dex
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cushings disease (pituitary tumor0
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what do you measure if they do not suppress with high dose dex
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ACTH
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what do you think of with high ACTH after high dose dex
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Ectopic ACTH
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what do you think of with low ACTH after high dose dex test
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adrenal tumor
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when would you suspect a patient has cushings
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high morning and night cortisol
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what is next test if patient has high morning and night cortisol
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24 hr urine
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what is diagnosis if 24hr urine is >100 but < 300
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probable
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what is done if 24hr urine is >300
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CRF stimulation test
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what other kind of stimulation test have we seen
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TRH=thyroid stimulation
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what is TRH used for
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hypothyroid with normal to low TSH
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CRF should make you think of what
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cushings
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what kind of cushings do you have with low acth after CRF stimulation
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ACTH independent
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what things cause ACTH independent cushings
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adrenal tumors
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what kind of cushings do we have with high ACTH after CRF test
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ACTH dependent
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what test is run with ACTH dependent cushings
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IPSS
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what is cause of cushings with negative IPSS
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ectopic
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what is cause of cushings with positive IPSS
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eutopic
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most common cause of cushings
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iatrogenic
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what are causes of pseudo cushings
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ETOH abuse
high serum cortisol |
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what is prognosis of untreated cushings
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death in 5yrs
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what should you think with a person on antihypertensives and still out of control
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secondary causes (cushings, pheo, primary aldo)
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