Endocrine
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| Aldosterone made in: | zona glomerulosa
🗑
|
||||
| Aldosterone function | Most important mineralcorticoid. Part of RAAS. Reabsorption of Na & excretion of K+. Prevention of hypovolemia & hyperkalemia
🗑
|
||||
| Cortisol function | intermediary metabolism (eg, counters fx of insulin). Vascular tone. Water balance. Anti-inflammatory
🗑
|
||||
| Cortisol level highest when? | in AM; in stress & exercise
🗑
|
||||
| Primary AI (AKA Addison dz) involves: | all 3 zones of adrenal gland (potential insufficiency of cortisol & aldosterone)
🗑
|
||||
| Addison dz: DDx can be narrowed by: | considering the abruptness of disease onset
🗑
|
||||
| Primary AI: abrupt onset: etiology | Adrenal hemorrhage, necrosis, thrombosis; meningococcal sepsis (Waterhouse-Friderichsen Syn); pseudo; coag dz; mets ca w/ bleed
🗑
|
||||
| Primary AI: slow onset: etiology | Auto-immune Adrenalitis; infxs Adrenalitis; Mets ca; congenital Adrenal Hyperplasia (CAH); Adrenomyeloneuropathy
🗑
|
||||
| Primary AI: clinical findings | Hotn & hypoglycemia. Hyperpigmentation (2/2 XS ACTH). Salt craving; low Na & high K. NAGMA. Vitiligo, pallor. Autoimmune thyroid dz. CNS sx in adrenomyeloneuropathy.
🗑
|
||||
| Secondary AI (slow onset): etiology | ACTH deficiency 2/2: Pit tumor / surgery / rad; craniopharyngioma; Megace; LT glucocorticoid tx (sudden D/C); sarcoidosis; hypothalamic tumor
🗑
|
||||
| AM cortisol results: | >18: r/o AI; <3: R/I AI; btw this range: need dynamic testing
🗑
|
||||
| ACTH stim test | 250 mcg Cosyntropin; measure cortisol before & 30 & 60 min after injxn; pre or post >18: R/O AI
🗑
|
||||
| Adrenal Insufficiency (AI) labs | AM cortisol (low). ACTH stim (low). Low aldosterone. Plasma ACTH (>100: primary AI) (normal: 5-45)
🗑
|
||||
| Adrenal crisis tx | Tx HYPOTENSION w/ volume (2 to 3 L of NS or D5NS); Give IV DEXAMETHASONE 4mg or IV HYDROCORTISONE 100mg TID (Dex preferred bc it won’t interfere w/ further dx testing & is long acting)
🗑
|
||||
| Chronic AI: maintenance therapy | Hydrocortisone 20mg AM / 10mg PM; Dex; prednisone
🗑
|
||||
| Tx chronic primary AI: besides cortisol, must also tx insuff of: | aldosterone: Fludrocortisone; check for postural HypoTN, orthostasis, serum K, renin; poss inc dose summer (inc persp Na loss) & dec dose in HTN (do not d/c altogether); NO K sparing diuretics for anti-HTN Rx
🗑
|
||||
| AI Prophylaxis: Steroids in Surgery | Give pre-op hydrocortisone / continue 24 hrs; cut dose by 50% after first 24 h; cut dose by 50% each day until return to maint level (small procedures: give single dose of HC IV beforeprocedure)
🗑
|
||||
| Cushing syndrome: ACTH-independent: | Adrenal lesion: exogenous source; Plasma ACTH level is low (< 5 pg/mL)
🗑
|
||||
| Cushing syndrome: ACTH-dependent: | Plasma ACTH normal / high (>15 pg/mL). Ectopic ACTH or CRH production, adrenal ca/adenoma, pituitary adenoma (Cushing dz).
🗑
|
||||
| ACTH-dependent Cushing: to distinguish between ectopic & pituitary: | 24h urine free cortisol. CRH-Stimulation test. LD & HD dex suppression. Petrosal sinus sampling. Octreotide scintigraphy to localize ectopic source. MRI
🗑
|
||||
| Cushing syndrome: tx | Surgical resection: transnasal transsphenoidal resection of pituitary adenomas; adrenal tumor resection. Bilateral adrenalectomy (uncommon). Pharmacologic adrenal blockade; ketoconazole.
🗑
|
||||
| Hirsutism / virilization: etiology | Idiopathic (Familial); PCOS; Androgen-secreting adrenal adenomas or carcinoma; Ovarian tumors; Glucocorticoid resistance
🗑
|
||||
| Hirsutism / virilization: etiology: ACTH-dependent causes | Congenital Adrenal Hyperplasia; ACTH-dependent Cushing Syn
🗑
|
||||
| PCOS LH:FSH ratio | >2.0 common
🗑
|
||||
| Androgen-secreting adrenal adenomas | Rare; high serum androgen conc remain elevated despite Dex suppression
🗑
|
||||
| Androgen-secreting adrenal ca prevalence | More common than adenomas
🗑
|
||||
| Androgen-secreting adrenal carcinomas | usu > 5 cm at dx; Very high DHEA, DHEA sulfate; No response to HD Dex Suppression
🗑
|
||||
| Hirsutism / virilization: lab eval | Serum testost (total & free); androstenedione (>1000: ovar adrenal neoplasm); DHEAS (>700: adrenal source of androgen xs; Need adrenal CT to detn if hyperplasia or ca)
🗑
|
||||
| Hirsutism / virilization: Imaging | Pelvic Exam & US; Abd CT (esp adrenal glands/ fine cuts): adenoma / ca / hypertrophy
🗑
|
||||
| CAH | Enzyme defects in adrenal steroid hor synth -> insuff cortisol +/-mineralocorticoid; classically with an assoc androgen excess
🗑
|
||||
| CAH: classical forms | Salt-wasting form; Virilizing Syndromes
🗑
|
||||
| CAH: nonclassical forms | Late-onset: women = hirsutism & menstrual irreg which can mimic PCOS; Men/boy: androgen excess can be asymptomatic
🗑
|
||||
| Hirsutism / virilization: Tx | Stop any offending meds; Med tx options; Interventional tx options (Postmeno F can undergo lap bilat oophorectomy, if scans are nml; small hilar cell tumors of ovary may not be visible on scans
🗑
|
||||
| PCOS Tx options | Oral Contraceptives (beware DVT); Metformin; Anti-androgen ( if NOT PG): Aldactone (spironolactone), Finasteride, Flutamide
🗑
|
||||
| Primary hyperaldosteronism: clinical findings | Hypertension; Mx Sx (d/t hypokalemia): cramping, weakness, periodic paralysis. Often few clinical sx (Dx from lab abnormalities)
🗑
|
||||
| Primary hyperaldosteronism: labs | BMP (low K, metab alkalosis). Serum renin & aldosterone ( Aldo/renin ratio >20 is suspicious). 24-hr urine aldost (high in setting of low renin (<5mcg/dL) suspicious). Saline-loading. 18-OH corticosterone
🗑
|
||||
| Primary hyperaldosteronism: labs: 18-OH corticosterone | indicative of aldosterone producing adenoma (APA)
🗑
|
||||
| Primary hyperaldosteronism: imaging | Abd CT (esp of adrenals); Adrenal vein sampling: for localization (cath of left an&d right adrenal veins & the IVC, looking for lateralization of elevated aldosterone level
🗑
|
||||
| Primary hyperaldosteronism: issues in evaluation | Hold aldactone, CCB, ACEI. At least 150mEq of Na intake daily (to suppress aldosterone production)
🗑
|
||||
| Primary hyperaldosteronism: presenting forms | APA (Conn dz, 65%). Bilateral hyperplasia of zona glomerulosa (35%). Primary adrenal hyperplasia. Adrenal carcinoma
🗑
|
||||
| Tx for aldosterone producing adenoma (APA): | surgical (effective only in patients with unilateral disease). Angioplasty if RAS.
🗑
|
||||
| Primary hyperaldosteronism mgmt for poor surgical candidate | Mineralcorticoid receptor antagonists: Spironolactone (DOC) or Eplerenone. CCB. ACEI
🗑
|
||||
| Pheochromocytoma = | dz of adrenal medulla (site of catecholamine prodn)
🗑
|
||||
| Pheochromocytoma: 5 P’s | pain; pallor (ortho hypoTN); palpitations; pressure (HTN); perspiration
🗑
|
||||
| Pheochromocytoma; rule of 10 | 10% of dz are: extra-adrenal; bilateral; familial; malignant; not assoc w/ HTN
🗑
|
||||
| Pheochromocytoma: Dx | 24 hr urine (for Catecholamines & Metabolites: Metanephrines / VMA); Serum metanephrines/ plasma catecholamines; Imaging
🗑
|
||||
| Pheochromocytoma: Med mgmt | Alpha adrenergic-blockade, then beta-blockade PRN. NEVER beta before alpha (may worsen HTN crises). CCB may be better tolerated than alpha-blockade.
🗑
|
||||
| Pheochromocytoma: Tx of choice | Surgical resection is TOC. Need adequate a-blockade pre-op. Caution post-op comps (labile BP, hotn/shock, hypoglycemia)
🗑
|
||||
| Tertiary AI etiology | low levels of corticotropin-releasing factor
🗑
|
||||
| Deficiency of which adrenocortical hormone is seen in secondary AI? | Glucocorticoids only (esp cortisol). Aldosterone normal.
🗑
|
||||
| Cushing syndrome imaging | Adrenal CT. CXR & MRI for ectopic site. DEXA
🗑
|
||||
| Hypercortisolism results in: | decreased protein synthesis, increased protein catabolism, nitrogen wasting, glucose intolerance.
🗑
|
||||
| Cushing clinical features | HTN, Wt gain/central obesity, moon face, buffalo hump, supraclavicular fat pads. Mx weak, fatigue. Poor wound healing, purple striae. Thin hair. Dysmenorrhea. Osteoporosis.
🗑
|
||||
| Cushing testing: late afternoon cortisol level: | elevated level suggests lack of physiologic dip
🗑
|
||||
| Cushing Disease surgery | Transphenoidal microsurgical removal (if proven Cushing dz)
🗑
|
||||
| Secondary hyperaldosteronism is due to: | increased renin (eg, in RAS or renal hypoperfusion like CHF or hypovolemia)
🗑
|
||||
| Primary hyperaldosteronism MOA | High aldosterone -> Na reabsorption -> volume expansion, HTN -> low K (2/2 ion exchange) -> AGMA
🗑
|
||||
| Pheochromocytoma patho | tumor of chromaffin tissue from adrenal medulla -> secretes datecholamines (epi, norepi). May be 2/2 surgery, PG, exercise, TCAs, Reglan, opioids
🗑
|
||||
| Recurrent HA, HTN despiteBP meds, sweating, severe HA, glucosuria, abnormal urinary catecholamines & metanephrines = | Pheochromocytoma
🗑
|
||||
| Group of familial disorders that affect multiple endocrine organs = | MEN (multiple endocrine neoplasia)
🗑
|
||||
| MEN patho | Auto dominant abnormalities -> hyperplasia or neoplasms
🗑
|
||||
| Types of MEN | 1: Wermer syndrome. 2a: Sipple syndrome. 2b: Sipple tumors w/less preponderance of PTH hyperplasia +marfanoid & multiple neuromas
🗑
|
||||
| Wermer syndrome | Affects PTH (90% of Wermer), pit adenoma, panc tumors (secrete insulin, gastrin, VIP, and serotonin.)
🗑
|
||||
| Sipple syndrome | Thyroid (medullary carcinoma producing calcitonin), PTH, adrenals (pheo), and Hirschsprung dz
🗑
|
||||
| Wermer syndrome workup | Measure PTH & Ca levels. Image pancreas & pituitary
🗑
|
||||
| Sipple syndrome 2a workup | Measure PTH, urinary catecholamines, calcitonin. Image adrenals
🗑
|
||||
| Sipple syndrome 2b workup | Same as for 2a plus eval for mucosal neuromas & marfanoid features
🗑
|
||||
| HyperPTH in MEN type 1: tx | Cinacalcet
🗑
|
||||
| Paraneoplastic endocrine syndromes: most common ectopic hormones | ACTH produced by SCLC & other carcinoids. ADH from SCLC, rarely prostate / cervical. PTH-related protein from squamous cell lung ca
🗑
|
||||
| Paraneoplastic endocrine syndromes: clinical features | Cushing syndrome. SIADH. Hypercalcemia of malignant dz (in breast ca & myeloma, 2/2 local osteolytic features)
🗑
|
||||
| In pt with high Ca and low PTH, suspect: | cancer (paraneoplastic syndrome)
🗑
|
||||
| Cushing pathology | Pituitary adenoma (small basophilic intrasellar tumor). Adrenocortical adenoma (lipid-rich cells in cords). Adrenocortical hyperplasia. Ectopic (lung, thymus, pancreas)
🗑
|
||||
| Catecholamines (eg's) | Epinephrine, norepinephrine, dopamine
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
Abarnard
Popular Medical sets