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46 Cards in this Set
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Another name for Primary Adrenal insufficiency
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Addison's Dz
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Dx:
shock, dehydration, confusion, vomiting, hyperK and Hypoglycemia What are the (3) causes? |
Addisonian (or adrenal) crisis
causes: Hemorrhage; Sepsis; Trauma |
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(2) main causes of Addison's Dz
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Autoimmune (80%);
TB (15%) |
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MCC of Secondary adrenal insufficiency
(2) other causes |
MCC:
Exogenous steroid drugs others: Sheehan's syndrome; Pituitary infarct |
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How is Aldosterone made?
(2) functions |
Angiotensin II acts on the zona glomerulosa to convert cortisone to aldosterone
Functions: Increase sodium reabsorption; secretion of K+ and H+ |
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What does a deficiency in aldosterone cause w/ electrolytes?
(2) |
HyperK
HypoN |
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Dx:
18-yo man w/ hemophilia A who was recently mugged (receiving multiple blows to head and abdomen) is now complaining of dizziness, abdominal pain, dark patches on his elbows and knees, and uncontrollable cravings for pizza and french fries |
Primary Adrenal Insufficiency
(Addison's Dz) |
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How is secondary insufficiency distinguished from Addison's Dz?
(3) |
No hyperpigmentation;
Normal aldosterone secretion; Signs of hypopituitarism (hypothyroidism or hypogonadism) |
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What is Cortisol's relation to glucose?
(2) |
Stimulates gluconeogenesis by increasing protein and fat catabolism;
Decreases utilization of glucose and sensitivity to insulin |
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How does cortisol promote an anti-inflammatory state?
(3) |
Inhibits Arachidonic Acid;
Inhibits IL-2 production; Inhibits release of histamine from Mast cells |
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Definition:
Hemorrhagic necrosis of the adrenal medulla during the course of meningococcemia |
Waterhouse-Friderichsen Syndrome
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Dx:
hyperpigmentation, salt cravings, orthostatic hypotension, amenorrhea |
Addison's Dz
(primary adrenal insufficiency) |
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Describe the ACTH (Cortrosyn) test to Dx Adrenal insufficiency etiology
How does it distinguish b/t primary and secondary? |
Give ACTH and measure at zero and 30 minutes.
A level of < 18 at 30 = adrenal insufficiency Measure plasma ACTH after test: Primary = high ACTH Secondary = low ACTH |
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Tx for adrenal insufficiency
what additional Tx for Addison's only? |
Tx:
Glucocorticoid replacement (especially at times of stress) additional for Addisons: Mineralcorticoid replacement |
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What disease presents with the exact opposite of Addison's?
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Cushing's Dz
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Definition:
Symptoms of excess Cortisol production |
Cushing's syndrome
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Definition:
Cushing's syndrome caused by excess ACTH secretion of pituitary |
Cushing's disease
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What lung cancer is associated w/ ectopic ACTH production?
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Small (Oat) cell lung CA
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Etiology of Cushing's syndrome (Adrenal excess)
(3) |
Exogenous corticosteroid therapy;
Adrenal neoplasm; Ectopic ACTH production |
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Dx:
HTN, hair loss, central obesity, hump on the back of neck, abdominal purplish striae, hirsuitism, proximal muscle weakness, osteoporosis |
Cushing's syndrome
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How is the ectopic ACTH Sx different from the ACTH Sx released directly from the adrenals?
Why? |
Ectopic ACTH Sx:
Weight gain and proximal muscle weakness only B/c: the ACTH in ectopic from is usually the inactive form. |
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How can Cushing's Dz be distinguished from Cushing's Syndrome?
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Cushing's Dz:
presence of Hyperpigmentation |
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Dx:
42-yo woman on long-term steroids for asthma has excess adipose tissue in her neck and upper trunk, a wide "moon face", and very fine hair |
Cushing's Syndrome
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(2) main lab tests to Dx Cushing's Syndrome
which is more specific as to finding the etiology? |
Overnight Dexamethasone Suppression test
High-Dose Dexamethasone Suppression test (more specific) |
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Describe the Overnight Dexamethasone test
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1 mg of dexamethasone is given at night, then plasma cortisol is measured in the morning.
if < 5ug/100mL, it EXCLUDES Cushing's as the Dx |
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What are the 3 Dx from Dexamethasone Suppression test & ACTH that follows?
(3 results from test) |
Give 8 mg dexamethasone, then measure ACTH:
1. If ACTH is decreased or undetectable w/ no supression = Adrenal etiology 2. ACTH is Normal or Increased w/ no supression = Ectopic ACTH etiology 3. ACTH is High w/ partial supression = Pituitary etiology |
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What are the electrolyte (Cl, K and Na) findings w/ Cushing's syndrome?
(3) What is found in urine? |
Hypochloremia;
HypoK; HyperN In Urine: 24-hour Urinary free cortisol > 100 ug/24hr |
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Tx of Cushing's from Pituitary adenomas
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Transsphenoidal surgery
(radiation for children and refractory to surgery) |
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Tx of Cushing's from Adrenal Adenoma
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Unilateral resection, followed by 3 to 12 months of glucocorticoid replacement
(until normal adrenal comes out of suppression) |
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Tx of Cushing's from Bilateral Adrenal Hyperplasia
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Bilateral resection and lifelong replacements of glucocorticoids and mineralcorticoids
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Tx of Cushing's from Ectopic ACTH production
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Remove source of neoplasm
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Definition:
Isolated excess production of Aldosterone - Another name for it? |
Hyperaldosteronism
"Conn's syndrome" |
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Etiology of Conn's syndrome
(2) Which is MCC? |
1. Unilateral aldosterone-producing Adenoma
(MCC) 2. Bilateral hyperplasia of Zona Glomerulosa (idiopathic) |
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Dx:
HTN, signs of HyperK (muscle cramps, palpitations), signs of glucose intolerance (polyuria, polydipsia); may also be asymptomatic |
Conn's syndrome
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Dx test for Conn's syndrome
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Measure plasma aldosterone to plasma renin activity ratio
a ratio > 20 = Conn's syndrome (hyperaldosteronism) |
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Dx:
44-yo woman has HTN, muscle cramps and excessive thirst |
Hyperaldosteronism
(Conn's syndrome) |
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What is the Tx for Conn's syndrome if it is due to hyperplasia?
(2) |
1. Spirolactone or ACEi to control BP
2. Low-sodium diet |
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Definition:
tumor of the adrenal medulla resulting in the intermittent release of catecholamine excess |
Pheochromocytoma
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(4) Disease Etiologies of Pheochromocytomas
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MEN II:
(Pheochromocytoma, PTH tumor, medullary thyroid CA); MEN III: (Pheochromocytoma, PTH tumor, mucosal Neuromas); Neurofibromatosis; Von Hippel-Lindau Dz |
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Dx:
Pheochromocytoma, retinal angioma, CNS hemangioblastomas, renal cell CA, pancreatic pseudocysts, ependymal cystenoma |
Von Hippel-Lindau Dz
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Dx:
38-yo woman on labetalol presents w/ poorly controlled hypertension, frequent headaches and palpitations |
Pheochromocytoma
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what are the 5 "H" Sx of pheochromocytoma?
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HA;
HTN; Hot (diaphoretic); Heart palpitations; Hyperhidrosis (hand sweating) |
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Dx test for Pheochromocytoma
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Elevated urine Vanillylmandelic Acid
(urine catecholamines) |
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Tx for pheochromocytoma
(2) |
Surgical resection of mass;
Alpha-adrenergic blocker (may also add B-blocker) |
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What is a possible misdiagnosis of Pheochromocytoma?
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Anxiety disorder
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What Dx is known for the "Rule of 10s":
10% are extra-adrenal; 10% are bilateral; 10% are malignant; 10% are familial; 10% are pediatric; 10% calcify; 10% recur after resection |
Pheochromocytoma
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