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Endocrine 2/3

Adrenals

QuestionAnswer
What is the difference in androgen production between iatrogenic Cushing's syndrome and Cushing's disease? Iatrogenic has no excess androgens b/c the exogenous steiod suppresss androgen production by the adrenals. In Cushing's disease, androgen excess is common.
Which type of lung cancer can cause ectopic ACTH production? Small cell (2/3 of cases). (Also bronchial carcinoids and thymomas can cause ectopic ACTH production)
What effect does cortisol have on immunity? Impairs it (inhibits PMNs and T cells)
Which is more likely to have hyperpigmentation: Cushing's syndrome or Cushing's disease? Cushing's disease (due to elevated ACTH levels)
Which serum cortisol level on an overnight low-dose DXM suppression test effectively rules out Cushing's syndrome? Serum cortisol <5 (serum cortisol >5 or 10= Cushing's syndrome use high DXM suppression to determine cause)
What's the diagnosis?: high dose DXM test with >50% reduction in Cortisol levels Cushing's disease
What's the diagnosis?: high dose DXM test with no cortisol suppression and high plasma ACTH ectopic ACTH-producing tumor
What's the diagnosis?: CRH stimulation test with increase in ACTH/cortisol levels Cushing's disease
What's the diagnosis?: CRH stimulation test with no increase in ACTH/cortisol levels Ectopic ACTH secretion or adrenal tumor
Which syndrome is associated with pheochromocytoma? MEN II
What is the MC site of extra-adrenal pheos (10% of pheos)? organ of Zuckerkandl, located at aortic bifurcation
If you suspect an adrenal tumor or hyperplasia causing Cushing's syndrome, what test/lab should be ordered? Adrenal imaging
What studies should be ordered to confirm a diagnosis of ectopic ACTH-producing tumor? Chest CT, Abdominal CT, and Octreotide scan
What is the nature of BP in pheos? Persistently high BP with episodic severe HTN
Name 3 lab findings in pheo. Hyperglycemia, hyperlipidemia, and hypokalemia
Pt presents with headache, profuse sweating, palpitations, and fear/sense of impending doom. Likely dx? Pheo until proven otherwise
Best urinary indicator of pheo? Metanephrine
How do you know a pheo must be adrenal? Elevated urine/serum epinephrine (non-adrenals cannot methylate norepi--> epi)
Tx of choice for pheo? Surgical resection with early ligation of venous draininage (ligation lowers possibility of catecholamine release/crisis); also medical with alpha blockers (phenoxybenzamine)
3 MEN I (Werner's) 1. Parathyroid hyperplasia 2. Pancreatic islet cell tumors (Z-E syndrome) 3. Pituitary tumors
3 MEN IIa (Sipple's) 1. Medullary thyroid CA 2. Pheo 3. Hyperparathyroidism
4 MEN IIb 1. Mucosal neuromas 2. Medullary thyroid CA 3. Marfanoid body habitus 4. Pheo
Hypertensive pt with hypokalemia who is not on diuretic and has no peripheral edema? Suspect hyperaldosteronism
Aldosterone-producing adrenal adenoma Conn's (hyperaldosteronism)
What causes nocturnal polyuria in primary hyperadolsteronism? Hypokalemia
Plasma aldosterone: renin level ____ warrants investigation for primary hyperaldosteronism >30
What result of a saline infusion rules out primary hyperaldosteronism? <8.5ng/dL
Tx of choice for adrenal adenoma causing hyperaldosteronism? Surgerical resection (curative)
Tx of choice for bilateral adrenal hyperplasia causing hyperaldosteronism? Spironolactone (inhibits action of aldost). Surgery is NOT indicated!
Primary adrenal insufficiency= Addison's disease
MCC of primary adrenal insufficiency worldwide? In Western world? TB worldwide; autoimmune Western
MCC secondary adrenal insufficiency? Pts on long-term steroid therapy (pts with serious illness or trauma unable to release appropriate amt of cortisol); also MCC adrenal insufficiency overall
Addison's effect on: glucose, BP, pigmentation hypOglycemia, hypOtension, hyperpigmentation (seen in primary ONLY)
Why is hyperpigmentation not seen in secondary adrenal insufficiency? B/c ACTH levels are low in secondary AI (either pit is not releasing ACTH b/c it's low-functioning or exogenous steroids are suppressing release of ACTH)
Addison's effect on: aldosterone levels, sodium levels, volume status, and potassium levels Low aldosterone, low sodium, hypovolemia, hyperkalemia
How can ACTH test distinguish btwn primary and secondary adrenal insufficiency? Primary: cortisol will not increase sufficiently with an ACTH infusion Secondary: after 4-5 days of treatment, adrenals "wake up" and begin responding normally to ACTH stimulation (will be sluggish initially)
What test should be ordered if secondary or tertiary adrenal insufficiency is diagnosed? MRI of brain (pit/hypothalamus)
Tx for primary adrenal insufficiency? Daily oral glucocorticoid (hydrocortisone or prednisone) + daily fludrocortisone (mineralcorticoid)
Tx for secondary adrenal insufficiency? Daily oral glucocorticoid (prednisone or hydrocortisone); daily mineralcorticoid (fludrocortisone) in unnecessary
MCC of congenital adrenal hyperplasia(CAH)? 21-hydroxylase deficiency (11-hydroxylase is 2nd MCC)
What causes the hyperplasia in congenital adrenal hyperplasia (CAH)? Decreased cortisol and aldosterone production--> increased ACTH--> hyperplasia of glands
What causes the virilization seen in CAH? precursors to cortisol and aldosterone build up--> shunted toward synthesis of androgens (DHEA, testosterone) --> virilization
Females infants born with CAH? Males? Ambiguous genitalia, but normal female ovaries and uterus. Male infants have no genital abnormalities.
Emesis, dehydration, hypOtension, and shock in first 2-4 weeks of life? Salt-wasting form of CAH
CAH effect on: sodium, potassium, glucose hypOnatremia,hyperkalemia, hypOglycemia (due to lack of cortisol)
How is CAH diagnosed? High levels of 17-hydroxyprogesterone in serum
Tx for CAH? Medical: use cortisol and mineralocorticoid to shut off excess ACTH secretion Surgical: correction of genital abnormalities recommended
Created by: sarah3148