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Endocrine-ICM
Disorders of the Adrenal Gland
20
Medical
Graduate
11/05/2010

Additional Medical Flashcards

 


 

Cards

Term
How does Aldosterone affect renin levels
Definition
Decreases the release of renin
Term
What is the first think you should check when suspecting an ACTH-Independant Cushing's Lesion
Definition
Exogenous steroid use
Term
How do you work up a patient suspected of Cushing's
Definition

A) 24-hr Free cortisol,

Alts: Late night Cortisol, Low dose Dexamethasone suppression(night)

B)Plasma ACTH

1)ACTH Dep: Pituitary/Chest imaging

2)ACTH Indep: Abdominal Imaging

Term
What are some tests to discern the cause of a ACTH-dependant cushing's patient if the imaging studies are inconclusive
Definition

High Dose Dexamethasone(Pituitary has more Negative feedback)

Petrosal Sinus Sampling(Ratio of petrosal to plasma ratio >3 suggests Pituitary)

Term
What is the treatment for a cushing's patient with Nodular Adrenal Disease
Definition
Bilateral Adrenalectomy
Term
What are some signs of mineralocorticoid excess?
Definition

Edema

HPTN

Hypokalemia

Metabolic Acidosis

 

Term
What is the cause and treatment of glucocorticoid supressible hyperaldosteronism
Definition

Auto Dom disorder of adrenal cortex releasing aldosterone in response to ACTH levels

Treatment: Corticosteroids

Term
How would you work up a patient suspected of Mineralcorticoid excess
Definition

Plasma Aldosterone/Renin Ratio(>20 suggestive of excess

High Salt Diet to confirm

Image Adrenals

Inconclusive imaging lends Renal vein Sampling

Term
What are some common disorders that mimic mineralcorticoid excess and their mechanism
Definition

DOC tumor

17 alpha Hydroxylase: Increased DOC

11B Hydroxylase: Increased DOC

11B Hydroxysteroid Dehydrogenase Type II or Cushing's: Aldosterone Agonist

Little's Syndrome: Hyperacive EnAC

Exogenous Mineralcorticoids: Licorice/Fludrocortisone

 

Term
How do you screen for Adrenal insufficiency? What signs beyond screening would suggest Primary versus secondary adrenal insufficiency
Definition

Cosyntropin Stimulation Test

Measure ACTH

Hyperpigmentation and Hypokalemia is usally specific to Primary Adrenal Insufficiency

Term
What is the most common cause of adrenal insuffieciency world wide and in the US
Definition

US: Addison's

World Wide: TB

Term
What would be the cause of low ACTH levels but a Cosyntropin response in a patient?
Definition
Acute Pituitary injury
Term
What is the treatment of Glucocorticoid Deficiency
Definition

Acute: High does Steroids

Stable: Maintainence Steroids

Primary: Mineralcorticoids and Corticosteroids

Term
What are some treatment options for Mineralocorticoid Deficiency
Definition

Fludrocortisone

High Salt Diet

Term
What are the signs, diagnosis, and treatment of 21 hydroxylase deficiency
Definition

Signs:Salt wasting

Hyperkalemia

Virulization in Girls

Only virulization is seen in Late-Onset

Diagnosis: 17 OH Progesterone

Treatment: Corticosteroids +/- Mineralocorticoids

Term
What are some general characteristics of pheochromocytoma
Definition

Signs(5 P's) Pallor, Palpitation, Perspiration, Pressure, Pain

Rule of Tens: 10% Bilateral, Malignant, Familial, Children, Recurrance, Extra-renal

Term
Why should you be precautious when you want to biopsy an Adrenal Mass
Definition
It may be a Pheochromocytoma, in which cause the biopsy may kill the patient
Term
How do you diagnose a Pheochromocytoma
Definition

24 hr Urine: Catecholamines/Metanephrines

Image with MRI or CT

If inconclusive: MIBG Scan, but give Iodide

Term
What is the treatment for pheochromocytoma?
Definition

Alpha then beta block

Surgery after stabilized

Term
How do you work up a patient with a adrenal mass found incidentally on imaging
Definition

Screen Pheo and Cushing's

If HPTN, Screen Aldosterone

>4cm->Surgery

<4cm->Observe

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