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30 Cards in this Set
- Front
- Back
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effect of IL6 and SE on ACTH/cortisol levels
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stress (IL6, SE) stimulates production but reducing cyclic production (lower waking levels of cortisol)
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factors that stimulate ACTH/cortisol production
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stress, darkness, IL6/SE, inflammation, ACTH production by tumors (stimulates adrenals)
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factors that inhibit ACTH/cortisol production
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light, exogenous compounds (like dex), pit dz or adrenal inflammation
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expected waking cortisol levels
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5-25 ug/dL (lowest on going to bed:1-7)
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value and limitations to cortisol
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easy to measure, hard to interpret with daily variation and protein-binding
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most sensitive direct test of cortisol
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urine cortisol - basically normally little cortisol in urine, but if positive that means binding capacity for metabolizing is exceeded
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if measured 17 ketosteroids in urine what are you measuring
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androgen production
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if measuring 17 oH steroids in urine what are you measuring
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cortisol, precursor and metabolites
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what does dex do
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suppresses ACTH production: amount required to suppress give you indicator of how functional the pit is
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dex tests: ON screen
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1 mg at 11 pm
expected "nl" result: ,2.5 ug/dl |
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dex low suppression test
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0.5 mg q 6h x 2 days confirmation of cushing screen
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dex high suppression test
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2 mg x q6 hr x 2 days or
8 mg at 11 pm urine cortisol <20% basal plasma cortisol <50 basal |
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alternative test for dex suppression
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corticosyn stim test (syn fragment of ACTH (1-24)
should expect cortisol >18ug/dl in 30 min |
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how does metyrapone test work
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blocks 11OH - cortisol will fall, ACTH and 11-OH will increase; 11OH should increase by at least 7ug/dl
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ectopic ACTH can be produced in what tumors
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lung small cell or carcinoids
thymoma |
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testing for adrenal insufficiency
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plasma cortisol <3 ug/dL, no stimulation
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what dictates internal sex
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presence of Y
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what dictates external sex
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presence of androgens
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things that stimulate renin??
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low blood flow
hyponatremia diuretics |
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things that inhibit renin production??
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NSAIDs, ANP/BNP, beta-blockers
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things that block aII activity???
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hypokalemia, anp/bnp, heparin, renal dz, ar blockers
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effects of hypoaldosteronism
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hypertension, hypokalemia, metabolic alkalosis
may not see hypokalemia if low salt diet |
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evaluation for hyperaldosterone
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1. rule out other causes (drugs/low salt diet), if HTN and hypokalemia persist, then
2. urine K (>30mmol over 24 hr), then 3. morning supine renin, aldo if both increased: secondary if decreased renin, increased aldo -primary |
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things that stimulate NE production
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Stress
Cold Standing Food Anxiety Caffeine b-Blockers Phenothiazines Nitroglycerine Vasodilators |
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metabolite of Dopamine
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HVA (product of MAO?)
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if wanted to find tumors making only epi
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measure fractionated catecholamines, metanephrines
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most sensitive test for evaluation of NE/epi production
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fractionated metanephrines, but not specific
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germline mutations for pheo
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VHL, RET, SDH
(not sure of what SDH is) |
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what markers could you use to follow neuroblastoma treatment
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VMA, HVA
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where does neuroblastoma met to
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liver, skin, BM
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