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Adrenal 3
Endocrine
| Question | Answer |
|---|---|
| HTN not responsive to meds | Renal artery stenosis (Infrarenal artery) |
| HTN w/ hypernatremia, hypokalemia | Primary Aldosteronism |
| Tetany, carpopedal spasm, hypocalcemia, cataracts; Chvostek & Trousseau sxs | Hypoparathyroidism |
| Exogenous corticosteroid use | Cushing syndrome |
| Dexamethasone suppression test | Cushing syndrome |
| Central obesity, abdominal stria, hyperglycemia, moon facies, buffalo hump, easy bruising | Cushing syndrome |
| Acute steroid withdrawal | Addison dz, crisis |
| Hyperpigmentation, hypoglycemia, orthostatic hypotension, hypotension not responsive to fluids, hypotension following an illness, trauma, or surgery | Addison dz, crisis (Low aldosterone; get Random or AM cortisol, ACTH stimulation test) |
| Worsening fatigue, wt loss, weakness, recurrent abdominal pain, hair loss, hyperpigmentation. Hyponatremia, hyperkalemia | Addison dz, crisis (Low aldosterone; get Random or AM cortisol, ACTH stimulation test) |
| Hyponatremia, hyperkalemia | Acute adrenal insufficiency (Addison crisis) |
| Polyuria (to 12 L/day), polydipsia. Dilute urine, Hypernatremia | Diabetes insipidus |
| Concentrated urine. Hyponatremia | SIADH |
| 45, X – low hairline, low set ears, webbed neck, short stature; shield chest, wide set nipples, infertility, lack of Secondary sex characteristics | Turner (gonadal dysgenesis |
| XXY male - short stature, low intelligence; small firm testes, gynecomastia, abn arm-body length | Klinefelter (hypogonadism) |
| Adrenal Insufficiency (AI) is: | Cortisol Deficiency |
| Primary Adrenal Insuff = | Addison Dz; adrenal gland does not respond to ACTH & not make adrenal hormones; 80% 2/2 autoimmune destn of adrenal cortex |
| Secondary Adrenal Insuff = | Pit does not make ACTH; adrenal is not stimulated to make cortisol |
| Tertiary Adrenal Insuff = | Suppression of CRH & ACTH by exogenous cortisol use |
| Primary Adrenal Insuff: Sx | Fatigue, hyponatremia, Hyperkalemia; ortho hypotension; delayed DTRs; Hyperpigmentation (from ACTH, only in primary AI); |
| Secondary adrenal insuff & RAAS | b/c secondary & tertiary adrenal insuff only involve low ACTH levels, the RAAS is still intact; Only cortisol is deficient. |
| Secondary adrenal insuff: Sx | Hyperkalemia & Hypotension are rarely seen; hyperpigmentation is not seen |
| Hypogonadotropic Hypogonadism = | F: Amenorrhea/Infertility; M: Erectile Dysfunction/ Infertility; Inappropriately Low FSH/LH for low estrogen or testosterone |
| Hypogonadotropic Hypogonadism: Eval | MRI Pituitary to assess for cause; Labs [prolactin; Iron/TIBC (Hemachromotosis); if estrogen level low, do Provera challenge] |
| Diabetes Insipidus = | No ADH; unable to conc urine; Polyuria; Polydipsia (esp night); UOP: 5-20 L / d; U spec grav < 1.0006; Hypernatremia; Normal Glucose |
| Diabetes Insipidus: Water Deprivation Test | Follow every 1-2 hrs: Na; UOP, Urine Osmo; Wt; BP & HR (Lying / Standing); Once serum osm >300 & urine osm has not increased, give 10 ug of vasopressin and follow urine osm |
| Water Deprivation Test: purpose | distinguish btw central and nephrogenic DI |
| Water Deprivation Test: Nephrogenic: | give AVP, kidney won’t respond, urine remains dilute |
| Causes of Diabetes Insipidus | Panhypopituitarism; Sarcoidosis/ Infiltrative Dz; Tumor; Trauma |
| Sx of Hypopituitarism | Secondary Hypothyroidism; Hypocortisolism (secondary adrenal insuff); Amenorrhea, Menopause, Erectile Dysfunction, Infertility; Polyuria/Polydipsia |
| Hyperprolactinemia: Sx (Women) | Galactorrhea; Amenorrhea; Infertility |
| Hyperprolactinemia: Sx (Men) | ED; Infertility; HA; Mass Effect (eg, from tumor in head); Galactorrhea (Pathognomonic) |
| Prolactinoma: tx w/ Dopaminergic Drugs if: | Macroadenoma; Mass Effect; Visual Field Deficit; Fertilty Desired |
| Prolactinoma: tx w/ Hormone Replacement if: | No Fertility Desired; Microadenoma; Visual Field Full; No Mass Effect; Estrogen or Testosterone is low |
| Acromegaly vs Gigantism | Acromeg: pit tumor secreting GH in adulthood; Gigantism: pit tumor secreting GH during PUBERTY before epiphyseal plate fusion; rapid linear growth, heights up to 8ft 11 in |
| Risks of LT exposure to GH include: | Arthropathy, neuropathy, CVD; HTN; resp dz; malig; CHO intol/DM |
| When to Suspect Acromegaly | MEN-1/other FH; Prominent brow; enlarged soft tissue of hands/ft, doughy handshake; splayed teeth, macroglossia; DM; HTN/ LVH; |
| Cushing syndrome | XS cortisol prodn; Exogenous (Use of synthetic Glucocorticoids); Endogenous = Cushing Dz; poss 2/2 adrenocortical tumor or nonpit ACTH-producing tumor (eg, SCLC) |
| Cushing syndrome: Sx | DM; HTN; Osteoporosis; Psychosis; Easy Bruising; central Obesity; Hyponatremia; Moon Facies; Buffalo Hump; prox Mx Wasting/weakness; Hirsutism; Purple Striae; Supraclavicular Fat; Infections; amenorrhea |
| Cushing Dz may be due to: | Pit ACTH overprodn; Ectopic ACTH Prodn; or Pit/Adrenal Adenoma producing cortisol |
| Cushing Dz: endogenous cortisol excess: | 75-80 % of cases; elevated cortisol levels do not suppress hypothalamic & ant pit secretion of CRH & ACTH |
| Ectopic ACTH production = | Nonpituitary Tumors secrete ACTH and do not respond to negative inhibition of high cortisol levels |
| Ectopic ACTH production poss d/t: | Small Cell Lung Ca; Carcinoid Tumors; Pheochromocytoma; Thymoma; Pancreatic Cell tumors; Medullary Ca of the Thyroid |
| Adrenal Hypercortisolism | ACTH & CRH are suppressed; Caused by: Adrenal Adenomas; Adrenal Ca; Micronodular or Macronodular Hyperplasia |
| Lack of stimulating hormone: causes | Pituitary (PanHypopituitarism); Hypothalamus (Stress, Tumor) |
| Hyperfunctioning of Endocrine Gland | Autonomous Fn of Primary Gland (Thyroid Toxic Adenoma); Autonomous Fn of Gland making Stim Hormone (Cushing Dz: ACTH); Ab’s that Stim Hor Receptor (Graves / TSI); Ectopic Prod Stim Hormone (Ectopic ACTH) |
| Hypercalcemia S/S | serum Ca >10.5 mg/dL; altered mentation, N/V; polyuria, polydipsia, stones |
Created by:
Abarnard
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