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32 Cards in this Set
- Front
- Back
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What is Cushing's Syndrome?
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Excessive cortisol
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What's the number one cause of Cushing's Syndrome?
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Exogenous steroids (will see decrease in ACTH)
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What are the 3 common endogenous causes of Cushing's Syndrome?
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70% = Cushing's disease
15% = Ectopic ACTH (small cell lung ca or carcinoid) 15% = adrenal adenoma/carinoma/hyperplasia |
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What are the 9 sx of Cushing's syndrome?
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Hypertension, moon facies, buffalo hump, truncal obesity, thinning/striae of skin, osteoporosis, amenorrhea, immunsupression and hyperglycemia (insulin resistance)
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What is Cushing's disease?
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Increased ACTH due to functioning pituitary adenoma, causing an increase in cortisol
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How would one dx the origin of a cushing's syndrome?
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Dexamethasone supression test
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How does a normal adrenal respond to a dexamethasone supression test?
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Decreased cortisol after low dose
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If you have an increase in cortisol after a low and high dose on a dexamethasone supression test, what are you thinking?
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1. Ectopic ACTH producing tumor (like small cell ca)
2. Cortisol producing adrenal adenoma/ carcinoma or adrenal hyperplasia |
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How does a patient with an ACTH producing pituitary tumor respond to a dexamethasone supression test?
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Increase in cortisol after low dose, decrease after high dose.
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What is Conn's syndrome?
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Primary hyperaldosteronism - due to aldosterone secreting adrenal tumor
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What are the clinical and laboratory findings in a patient with Conn's syndrome?
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HTN, hypokalemia, metabolic alkalosis, and low plasma renin.
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What are the causes of secondary hyperaldosteronism?
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Overactive renin-angiotensinogen due to renal hyoperfusion (renal artery stenosis, CHF, CRF, cirrhosis, nephrotic syndrome)
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How would you treat Conn's syndrome?
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Spironolactone - K sparing diuretic that works by blocking aldosterone
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What is Addison's disease?
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Chronic renal insufficiency due to adrenal atrophy or destruction
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What is the clinical difference between primary and secondary Addison's disease?
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Secondary = ↓ACTH from the pituitary and does not = ↓ aldosterone = no skin hyperpigmentation or hyperkalemia
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What are the 2 main sx of primary Addison's disease?
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Hypotension (↓ Na, volume contraction)
Hyperpigmentation of the skin |
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What is Waterhouse-Friderichsen syndrome?
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Acute adrenalcortical insufficiency due to adrenal hemorage
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What is Waterhouse-Friderichsen syndrome associated with?
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Neisseria meningitidis septicemia, DIC, and endotoxic shock
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What's the most common adult adrenal medulla tumor?
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Pheochromocytoma
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Where is a Pheochromocytoma derived from?
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Chromaffin cells
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What are the 3 products of a functioning Pheochromocytoma?
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NE, epinephrine, and dopamine
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What conditions are associated with Pheochromocytoma?
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Neurofibromatosis and MEN II
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How do you tx a Pheochromocytoma?
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Alpha antagonists (phenoxybenzamine = non-selective, irreversible blocker)
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What lab tests are elevated in a Pheochromocytoma?
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Blood catecholamines
Urine VMA (NE breakdown) and Metanephrine (epinephrine breakdown product) |
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Why's Pheochromocytoma the 10% tumor? (6 reasons)
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10%...malignant
bilateral extra-adrenal calcifications kids familial |
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What are the sx of a Pheochromocytoma?
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Episodic (5 P's): Pressure (inc BP), pain (h/a), perspiration, palpitations (inc HR), and pallor
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What's the most common adrenal medulla tumor in kids?
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Neuroblastoma
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What oncogene is neuroblastoma along the sympathetic chain associated with?
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N-myc
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What do you see in the urine of kids with adrenal medulla neurblastomas?
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Increased HVA (breakdown product of dopamine)
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What are the 8 main sx of hypothyroidism?
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Cold intolerance, weight gain, lethargy, weakness, constipation, dec reflexes, myxedema (face and perioribital), and cool dry skin with coarse brittle hair
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What are the 7 main sx of hyperthyroidism?
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heat intolerance, weight loss with inc appetite, hyperactivity, inc reflexes, CP and arrhythmias, diarrhea, and moist warm skin with fine hair
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What's the most common cause of hypothyroidism?
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Hashimoto's thyroiditis
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