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10 Cards in this Set
- Front
- Back
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Urinary metanephrine is a screening test for?
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Pheochromocytoma
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Symptoms of weakness, fatigue, and weight loss in combination with signs of hypotension and extensor hyperpigmentation.
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Addison’s Disease (Adrenal Insufficiency)
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A 40-year-old alcoholic male is being treated for tuberculosis, but he has not been compliant with his medications. He complains of increasing weakness and fatigue. He appears to have lost weight, and his blood pressure is 80/50 mmHg. There is increased pigmentation over the elbows. Cardiac exam is normal.
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Addison’s Disease (Adrenal Insufficiency)
Tuberculosis can involve the adrenal glands and result in adrenal insufficiency. |
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Measurement of serum cortisol baseline and then stimulation with ACTH will confirm the diagnosis.
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Addison’s Disease (Adrenal Insufficiency)
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Test is used to determine the adrenal reserve capacity for steroid production.
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ACTH Stimulation Test
Cortisol response is measured 60 min after cosyntropin is given intramuscularly or intravenously. |
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Cortisol response is measured 60 min after cosyntropin is given intramuscularly or intravenously.
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ACTH Stimulation Test
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In the advanced stage of Addison’s Disease (Adrenal Insufficiency), the most likely electrolyte abnormalities will be?
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Low serum Na+ & high serum K+
Hyponatremia is due to loss of sodium in the urine (aldosterone deficiency) and movement of sodium intracellularly. Extravascular sodium loss causes hypotension. Hyperkalemia is due to aldosterone deficiency, impaired glomerular filtration, and acidosis. |
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Medication:
Addison’s Disease (Adrenal Insufficiency) |
Hydrocortisone BID + Fludrocortisone
2/3 of the dose of Hydrocortisone is taken in the morning and 1/3 at night in order to approach normal diurnal variation. The mineralocorticoid component of adrenal hormones also needs to be replaced (Fludrocortisone). |
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A 60-year-old woman comes to the emergency room in a coma. The patient’s temperature is 90°F. She is bradycardic. Her thyroid gland is enlarged. There is bilateral hyporeflexia.
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Myxedema Coma
An IV bolus of Thyroxine is given (300 to 500 µg), followed by daily IV doses. Glucorticoids are given concomitantly. IV fluids are also needed; rewarming should be accompanied slowly, so as not to precipitate cardiac arrhythmias. If alveolar ventilation is compromised, then intubation may also be necessary. |
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Treatment:
Myxedema Coma |
An IV bolus of Thyroxine is given (300 to 500 µg), followed by daily IV doses.
Glucorticoids are given concomitantly. IV fluids are also needed; rewarming should be accompanied slowly, so as not to precipitate cardiac arrhythmias. If alveolar ventilation is compromised, then intubation may also be necessary. |
