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32 Cards in this Set
- Front
- Back
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ADRENAL MEDULLA SECRETES
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NOREPINEPHRINE AND EPINEPHRINE
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MAJOR SIGNALS FOR RELEASE OF CATECHOLAMINES
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DECREASED BP, DECREASED BLOOD VOLUME, DECREASED BLOOD GLUCOSE, SEVERE ILLNESS, SEVERE EMOTIONAL STRESS
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PHEOCHROMOCYTOMA
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CATECHOLAMINE SECRETING TUMOR OF CHROMAFFIN CELLS ARISING FROM THE ADRENAL MEDULLA OR ANY LOCATION ALONG THE SYMPATHETIC NERVOUS CHAIN
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PHEOCHROMOCYTOMA FOUND IN LESS THAN 1% OF PATIENTS WITH THIS CONDITION
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HYPERTENSION
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CLINICAL PRESENTATION OF PHEOCHROMOCYTOMA
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HYPERTENSION- MAY BE PAROXYSMAL AND RESISTANT TO TX; HA. SWEATING, AND PALPITATIONS (TRIAD) AND OTHERS
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CLASSIC SYMPTOMS TRIAD IN PHEO
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HA, SWEATING, PALPITATIONS
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WHAT TYPE OF STIMULI CAN CAUSE PAROXYSMAL CATECHOLAMINE RELEASE?
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ACTIVITY, MEALS, ETOH, SMOKING, URINATION/STRAINING, EMOTIONAL STRESS, TRAUMA, PAON, GENERAL ANESTHESIA***, HORMONES/DRUGS
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SCREENING LABS DONE IN PHEO
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FREE T4, TSH, CBC, ESR, GLUCOSE
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SPECIFIC TESTS FOR DX OF PHEO
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24 HR URINE FOR CATECHOLAMINES, 24 HR URINE FOR METANEPHRINES (METABOLITES- VMA)---DONE DURING OR RIGHT AFTER ACUTE EPISODE
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IN ER, WHAT TEST MIGHT WE DO IN PAROXYSMAL HYPERTENSION?
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DIRECT BLOOD AND URINE ASSAYS FOR EPI/NE OR PLASMA FREE METANEPHRINE/CATECHOLAMINES----WILL BE INCREASED
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IF LABS SUGGEST A PHEO, HOW DO WE LOCALIZE IT?
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1. CT OF ADRENAL GLANDS B/C IT IS THERE 90% OF THE TIME; IF NEGATIVE, DO CT OF ENTIRE ABDOMEN, CHEST, AND PELVIS
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COMPLICATIONS OF PHEO
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STROKE AND/OR SUDDEN BLINDNESS F/ HYPERTENSION; CARDIOMYOPATHY; CARDIAC ARRHYTHMIAS
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MANAGEMENT OF PHEO
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PREOP ALPHA BLOCKER OR CCB; B BLOCKER ONLY IF STILL TACHYCARDIC AFTER ALPHA BLOCKER AND THEN SURGERY
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IF YOU CANNOT DO SURGERY ON A PHEO, WHAT IS TX?
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METYROSINE---REDUCES CATECHOLAMINE SYNTHESIS
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WHAT ARE MULTIPLE ENDOCRINE NEOPLASIA (MEN)?
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FAMILIAL SYNDROMES WITH MULTIPLE ENDOCRINE GLAND INVOLVEMENT
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MOST COMMON MULTIGLANDULAR SYNDROME
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MEN 1- WERNER'S SYNDROME
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3 GLANDS INVOLVED IN WERNER'S SYNDROME
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HYPERPARATHYROIDISM, PANCREATIC ISLET CELL TUMORS, AND PITUITARY ADENOMAS
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THREE GLANDS INVOLVED IN MEN 2A OR SIPPLE'S SYNDROME
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PHEO, MEDULLARY THYROID CANCER, HYPERPARATHYROIDISM, AND HIRSCHSPRUNG'S DISEASE
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MANAGEMENT OF SIPPLE'S
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CHECK FOR PRESENCE OF PHEO AND THEN DO PROPHYLATIC THYROIDECTOMY
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TYPE OF ABNORMALITIES SEEN WITH MEN 2B
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PHEOS**, MEDULLARY THYROID CANCER**, MUCOSAL NEUROMAS, INTESTINAL ABNORMALITIES, AND SKELETAL ABNORMALITIES
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RECOMMENDED TX FOR MEN 2B
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PROPHYLACTIC THYROIDECTOMY AND THEN REPLACEMENT SYNTHROID
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MEDULLARY THYROID CANCER IS VERY _________.
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AGGRESSIVE
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MOST ADRENAL INCIDENTALOMAS ARE NONFUNCTIONAL, BUT WHEN THEY ARE NOT..WHAT ARE THE FOUR MOST COMMON POSSIBILITIES?
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CORTISOL PRODUCING, PHEOS, ALDOSTERINOMA, METASTATIC DX
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EVALUATION FOR ADRENAL INCIDENTALOMAS
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24 HR URINE FOR METANEPHRINES AND CATECHOLAMINES (R/O PHEO0, 24 HR FREE CORTISOL (R/O CORTISOL PRODUCING), SERUM K AND ALDOSTERONE PLUS PLASMA RENIN ACTIVITY (R/0 ALDOSTERINOMA)
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IF LABS DO NOT SHOW A FUNCTIONAL INCIDENTALOMA, WHAT DO YOU DO?
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SERIAL CT AT 3 AND 12 MTHS WHEN LESS THAN 4 CM; THEN EVERY 2-3 YRS IF IT HASN'T GROWN
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IF ADRENAL INCIDENTALOMAS ARE GREATER THAN 4 CM, NOT LIKELY TO BE A MET FROM ANOTHER ORGAN, EVEN IF NONFUNCTIONAL- WHAT IS TX?
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SURGICALLY REMOVED AND BIOPSIED
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RED FLAGS FOR PRESENCE OF SECONDARY HYPERTENSION
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HYPOKALEMIA W/O DIURETIC RX, NEW PRESENTATION IN 50+, EARLY AGE W/O FAMILY HX, WELL CONTROLLED HTN NOW REFRACTORY, HTN IS PAROXYSMAL, ABSENCE OF OBESITY, SYMPTOMS INDICATING ENDOCRINE DISORDER
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TOP 4 ENDOCRINE CAUSES OF SECONDARY HTN
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THYROID DYSFUNCTION, HYPERALDOSTERONISM, PHEOCHROMOCYTOMA, CUSHING'S SYNDROME
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IF SECONDARY HTN DUE TO THYROID DYSFUNCTION IS SUSPECTED, DO WHAT?
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TSH, FT4
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IF SECONDARY HTN DUE TO HYPERALDOSTERONISM, DO WHAT?
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SERUM K, ALDOSTERONE, RENIN
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SECONDARY HTN DUE TO PHEO, DO WHAT?
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24 HR URINE CATECHOLAMINES AND METANEPHRINES
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SECONDARY HTN DUE TO CUSHING'S SYNDROME, DO WHAT TESTS?
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LOOK AT OBJECTIVE CLINICAL FINDINGS AND DO A 24 HR UFC
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