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Adrenal Disorders
Downstate > MS2 Endocrine > Adrenal Disorders
46
Medical
Graduate
03/04/2011

Additional Medical Flashcards

 


 

Cards

Term
effects of cortisol on metabolism, bone, skin, renal, and immune systems
Definition
increases GNG, protein catabolism, and lipolysis; inhibits bone formation, breaks down collagen; can bind to mineralcorticoid receptors; inhibits immune system
Term
clinical presentation of Cushing's Syndrome: metabolic, bone, skin, renal, and immune
Definition
muscle wasting, obesity, moon facies, hirsutism, osteoporosis/fractures, thin skin, striae, hypertension, multiple infections
Term
how do you establish hypercortisolism?
Definition
24h urine free cortisol test OR overnight dexamethasone suppression test
Term
what can cause a false positive on UFC test? (4)
Definition
alcohol, stress, carbamezepine, high urine volume
Term
alcohol, stress, renal failure, and obesity may give you a _____ on the overnight dexamethasone suppression test
Definition
false positive
Term
you have confirmed that a pt has hypercortisolism. what is your next step?
Definition
plasma ACTH. high ACTH -> pituitary disease or ectopic tumor. low ACTH -> primary adrenal disease
Term
how do you confirm a pituitary ACTH secreting tumor?
Definition
MRI or IPSS/CSS. A lesion >5mm -> CD. A central-to-peripheral gradient > 2:1 -> CD.
Term
how do you confirm an adrenal tumor?
Definition
CT scan or IPSS:periphery < 3:1
Term
how do you confirm an ectopic ACTH tumor?
Definition
IPSS. IPSS:periphery <3:1 -> ectopic ACTH tumor
Term
tx for Cushing's Disease
Definition
surgery is best. medical tx includes metyrapone, ketoconazole, mifepristone, mitotane, and aminoglutethimide
Term
what drug inhibits 11beta-hydroxylase
Definition
metyrapone
Term
what drug inihibits 11beta-hydroxylase and cholesterol side chain cleavage
Definition
aminoglutethimide
Term
causes of primary adrenal insufficiency (5)
Definition
autoimmune (Addison's); TB, infections, tumor, hemorrhage
Term
most common cause of secondary adrenal insufficiency
Definition
space-occupying lesion in pituitary (abscess, aneurysm, tumor)
Term
adrenal hormone levels in primary adrenal insufficiency vs. secondary adrenal insufficiency
Definition
primary: all decreased
secondary: normal aldosterone; decreased cortisol and sex hormones
Term
hyponatremia, hyperkalemia, hypotension, hypoglycemia, hyperpigmentation; dx?
Definition
primary adrenal insufficiency
Term
hyponatremia, no hyperkalemia, hypoglycemia, hypopigmentation; dx?
Definition
secondary adrenal insufficiency
Term
how do you establish adrenal insufficiency?
Definition
ACTH stimulation test. Measure cortisol. Neither primary nor secondary should respond.
Term
how do you distinguish primary from secondary adrenal insufficiency, diagnostically?
Definition
Measure PRA, aldosterone, and ACTH.
Primary: high PRA, low aldosterone, high ACTH
Secondary: normal PRA, normal aldosterone, low ACTH
Term
how do you dx acute adrenal insufficiency?
Definition
insulin challenge or overnight metyrapone.
insulin: hypoglycemia -> stress -> cortisol secretion. measure cortisol after 1h. cortisol>20ug/dl is normal.
overnight metyrapone: metyrapone inhibits 11-beta hydroxlyase. Measure DOC. DOC>7ug/dl is normal.
Term
tx for primary vs secondary adrenal insufficiency
Definition
primary: glucocorticoid + mineralcorticoid replacement
secondary: glucocorticoid replacement
Term
what enzymes are commonly mutated in CAH?
Definition
21-hydroxylase, 17a-hydroxylase, and 11b-hydroxylase
Term
what steroids are produced by 21-hydroxylase? 11b-hydroxylase? 17a-hydroxylase?
Definition
21-OH: aldosterone, cortisol
11b-OH: aldosterone, cortisol
17a-OH: cortisol, sex hormones
Term
precocious puberty in males, virilizing in females, +/- salt wasting, hyperkalemia if severe; dx?
Definition
21-OH deficiency
Term
asymptomatic male, hirsutism in females at puberty; no salt wasting; dx?
Definition
21-OH deficiency
Term
virilized females at puberty, precocious puberty in males, no salt wasting
Definition
21-OH or 11b-OH deficiency
Term
what prevents salt-wasting in 11b-hydroxylase deficiency?
Definition
DOC
Term
CYP11B1 defect
Definition
11b-OH deficiency
Term
CYP21A2 defect
Definition
21-OH deficiency
Term
ambiguous sex at birth in males; normal at birth for females; neither sexually mature; dx?
Definition
17a-OH deficiency
Term
HTN in ambiguous male; dx?
Definition
17a-OH deficiency
Term
HTN in a virilized female; dx?
Definition
11b-OH deficiency
Term
hypotension in a male with precocious puberty; dx?
Definition
21-OH deficiency
Term
HTN, no edema, decreased PRA, tetany, muscle spasms; dx?
Definition
primary aldosteronism
Term
HTN, no edema, increased PRA, tetany, muscle spasms; dx?
Definition
secondary aldosteronism
Term
what are the 2 causes of primary aldosteronism?
Definition
bilateral adrenal hyperplasia or unilateral adrenal tumor
Term
how do you screen for primary aldosteronism?
Definition
measure aldosterone:renin ratio
if AR ratio>15 and serum aldosterone>15ng/ml, then workup for primary aldosteronism
Term
most common cause of primary aldosteronism is...
Definition
bilateral adrenal hyperplasia
Term
who is recommended for screening? (4)
Definition
pts with refractory HTN, young pts with HTN, family hx, adrenal incidentaloma
Term
how do you confirm primary aldosteronism? (3)
Definition

adrenal CT scan, salt load and measure urine aldosterone, or volume expansion test

 

volume expansion: give 2L of saline IV over 4h; this should cause hyponatremia, suppress aldosterone secretion, and increase salt excretion; aldosterone>10ng/dl -> primary aldosteronism

Term
tx for bilateral adrenal hyperplasia vs. adenoma?
Definition
hyperplasia: eplerenone
adenoma: surgery
Term
pathology of secondary aldosteronism
Definition
renal artery stenosis reduces blood flow to glomeruli -> increases renin secretion -> increases aldosterone production
Term
HTN with decreased aldosterone and decreased PRA; dx?
Definition
SAME
Term
11b-hydroxysteroid dehydrogenase deficiency causes...
Definition
SAME
Term
pathogenesis of SAME
Definition
excess cortisol production due to 11b-hydroxysteroid dehydrogenase deficiency; cortisol can bind mineralcorticoid receptors
Term
tx for SAME
Definition
dexamethasone
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