Term
|
Definition
electrolyte balance (Na, K)
regulates blood pressure |
|
|
Term
| What system regulates blood pressure? |
|
Definition
| renin-angiotensin-aldosterone system (RAAS) |
|
|
Term
| Aldosterone secretion is regulated by ______ secretion in the kidney via ___________. |
|
Definition
|
|
Term
|
Definition
-promotes gluconeogenesis
-stress adaptation
-anti-inflammatory and immunosuppressant |
|
|
Term
| What actions do glucocorticoids have in the immune response? |
|
Definition
block cytokine production
may also kill T cells
regulation within the cells themselves |
|
|
Term
| What are the adrenal steroid hormones bound to? |
|
Definition
| transcortin or corticosteroid binding globulin (CBG) |
|
|
Term
| Where is CBG secreted from? |
|
Definition
|
|
Term
| Where does inactivation of adrenal steroid hormones mainly occur? |
|
Definition
|
|
Term
| How are adrenal steroid hormones excreted? |
|
Definition
|
|
Term
| What stimulates the release of catecholamines? |
|
Definition
| physical or mental stress |
|
|
Term
| formation pathway of epinephrine |
|
Definition
phenylalanine
tyrosine
DOPA
dopamine
norepinephrine
epinephrine |
|
|
Term
| Where are catecholamines produced? |
|
Definition
|
|
Term
| What does mineralocorticoid over-secretion cause? |
|
Definition
sodium retention (hypernatremia)
potassium depletion (hypokalemia) |
|
|
Term
| What does cortisol over-secretion cause? |
|
Definition
excess gluconeogenesis
excess glucose deposited as fat |
|
|
Term
| What does androgen over-secretion cause? |
|
Definition
masculinization
pseudohermaphroditism
precocious pseudopuberty
no effect in adult males |
|
|
Term
| chronic adrenocortical insufficiency |
|
Definition
|
|
Term
| essentials of diagnosis for Addison's disease |
|
Definition
weakness
fatigue
hypotension
increased skin pigmentation |
|
|
Term
| What is the most common etiology of Addison's disease? |
|
Definition
| idiopathic/autoimmune (80%) |
|
|
Term
| What would serum sodium and potassium levels be in a patient with Addison's? |
|
Definition
low sodium (hyponatremia)
high potassium (hyperkalemia) |
|
|
Term
| What would the serum calcium level be in a patient with Addison's? |
|
Definition
|
|
Term
| What would the BUN be in a patient with Addison's? |
|
Definition
|
|
Term
| What would the WBC count show in a patient with Addison's? |
|
Definition
moderate neutropenia
lymphocytosis
eosinophil count >300 |
|
|
Term
| What would the plasma cortisol and ACTH levels be in a patient with Addison's? |
|
Definition
|
|
Term
| What might a CBC show in a patient with Addison's? |
|
Definition
|
|
Term
| What would the fasting blood glucose level be in a patient with Addison's? |
|
Definition
|
|
Term
| What is the diagnostic lab result for Addison's disease? |
|
Definition
| plasma cortisol level low (<3 mcg/dl) at 8am, especially if accompanied by elevated plasma ACTH (>200 pg/ml) |
|
|
Term
|
Definition
|
|
Term
| What is the normal plasma cortisol level at 8am? |
|
Definition
|
|
Term
| What challenge test can you do to diagnose Addison's disease? |
|
Definition
cosyntropin stimulation test
synthetic ACTH (cosyntropin) given IM, serum obtained 30-60 min after, normally serum cortisol would rise at least 20 mcg/dl |
|
|
Term
| What imaging studies might you get in a patient with Addison's and why? |
|
Definition
chest x-ray--look for TB, fungal infection, cancer
CT--small non-calcified adrenals in autoimmune disease |
|
|
Term
| treatment of Addison's disease |
|
Definition
hydrocortisone (DOC)
2/3 in the morning, 1/3 in the evening |
|
|
Term
| When would an increased dose of hydrocortisone be required in someone with Addison's disease? |
|
Definition
|
|
Term
| What clinical disorders are associated with idiopathic adrenocortical insufficiency? |
|
Definition
primary ovarian failure
thyroid disease
diabetes mellitus
vitiligo
hypoparathyroidism
pernicious anemia
anorexia
multiple sclerosis |
|
|
Term
| prognosis for patient with Addison's disease |
|
Definition
| reasonably normal, as long as pt is very compliant with taking their meds and are knowledgeable about the condition |
|
|
Term
| acute adrenocortical insufficiency |
|
Definition
adrenal crisis
life-threatening condition that occurs when there is not enough cortisol |
|
|
Term
| When could adrenal crisis occur? |
|
Definition
-adrenal gland is damaged (Addison's, primary adrenal insufficiency)
-pituitary gland is damaged (secondary adrenal insufficiency)
-adrenal insufficiency is not properly treated |
|
|
Term
| essentials of diagnosis for adrenal crisis |
|
Definition
-low blood pressure
-rapid HR
-dehydration
-increased skin pigmentation (maybe)
-cosyntropin unable to stimulate increase in serum cortisol to 20 mcg/dl |
|
|
Term
| risk factors for adrenal crisis |
|
Definition
dehydration
infection or other physical stress
stopping treatment too soon |
|
|
Term
| treatment of adrenal crisis in the acute phase |
|
Definition
-maintain airway, breathing, circulation
-use coma protocol
-use aggressive volume replacement therapy (D5N5)
-correct electrolyte abnormalities |
|
|
Term
| In what order should electrolyte abnormalities be corrected when treating acute phase adrenal crisis? |
|
Definition
1. hypoglycemia
2. hyponatremia
3. hyperkalemia
4. hypercalcemia |
|
|
Term
| prognosis for adrenal crisis |
|
Definition
rapid treatment usually lifesaving
frequently unrecognized and untreated since it's manifestations mimic more common conditions
lock of treatment leads to shock that is unresponsive to volume replacement and vasopressors, resulting in death |
|
|
Term
| hormonal disorder caused by prolonged exposure of the body's tissues to high levels of cortisol |
|
Definition
|
|
Term
| essentials of diagnosis for Cushing's syndrome |
|
Definition
central obesity with moon face
buffalo hump
supraclavicular fat pads
protuberant abdomen
hirsutism
purple striae
elevated cortisol |
|
|
Term
| What is a common cause of Cushing's syndrome? |
|
Definition
| long-term use of corticosteroids (prednisone) |
|
|
Term
| What is the most specific lab test to diagnose Cushing's? |
|
Definition
24 hour urine for free cortisol
>50-100 mcg/day=Cushing's |
|
|
Term
| What is the dexamethasone suppression test used to diagnose? |
|
Definition
|
|
Term
| What condition is an androgen-dependent excessive male-pattern hair growth that is associated with PCOS? |
|
Definition
|
|
Term
| What is a condition in which androgen levels are sufficiently high? |
|
Definition
|
|
Term
| What lab finding is consistent with hirsutism and virilization? |
|
Definition
| elevated serum testosterone |
|
|
Term
| If serum testosterone is normal, an __________ cause for hirsutism is extremely unlikely. |
|
Definition
|
|
Term
|
Definition
idiopathic
familial
PCOS
insulin resistance
drugs |
|
|
Term
| What menstrual irregularity is common in women with hirsutism and/or virilization? |
|
Definition
|
|
Term
| What lab findings other than elevated testosterone are consistent with hirsutism and virilization? |
|
Definition
LH/FSH >2.0
hyperglycemia
elevated insulin (common in PCOS) |
|
|
Term
| What pharmacological treatment can be given for hirsutism and virilization? |
|
Definition
OCPs
spironolactone
topical hair growth retardant (Vaniqa)
insulin sensitizing agent (metformin) |
|
|
Term
|
Definition
| primary hyperaldosteronism |
|
|
Term
| What happens with Conn's syndrome? |
|
Definition
|
|
Term
| What are the most common causes of Conn's syndrome? |
|
Definition
unilateral adrenal adenoma
bilateral adrenal hyperplasia |
|
|
Term
| signs of primary hyperaldosteronism |
|
Definition
hypertension
hypokalemia
alkalosis |
|
|
Term
| symptoms of primary hyperaldosteronism |
|
Definition
headache
vision problems
fatigue
muscle cramps
weakness
numbness
temporary paralysis
increased urine
increased thirst |
|
|
Term
| What labs should you get in a patient to diagnose primary hyperaldosteronism? |
|
Definition
aldosterone
potassium
renin |
|
|
Term
| What lab findings are consistent with Conn's syndrome? |
|
Definition
high aldosterone
low renin
low potassium |
|
|
Term
| treatment of primary hyperaldosteronism |
|
Definition
total adrenalectomy (unilateral)
subtotal adrenalectomy (bilateral)
spironolactone
low sodium diet |
|
|
Term
| What risks do patients with primary hyperaldosteronism have if untreated? |
|
Definition
| complications associated with untreated hypertension (MI, heart failure, kidney damage, kidney failure, stroke) |
|
|
Term
|
Definition
rare catecholamine-secreting tumor
0.05-0.2% of hypertensive patients |
|
|
Term
| What are the 3 naturally occurring catecholamines? |
|
Definition
dopamine
norepinephrine
epinephrine |
|
|
Term
| What is significant about the blood pressure in a patient with a pheochromocytoma? |
|
Definition
|
|
Term
| What is the preferred diagnostic test for pheochromocytoma? |
|
Definition
|
|
Term
| treatment of pheochromocytoma |
|
Definition
| surgical removal of tumor |
|
|
