Endocrine
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| Aldosterone made in: | show 🗑
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| show | Most important mineralcorticoid. Part of RAAS. Reabsorption of Na & excretion of K+. Prevention of hypovolemia & hyperkalemia
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| Cortisol function | show 🗑
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| Cortisol level highest when? | show 🗑
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| show | all 3 zones of adrenal gland (potential insufficiency of cortisol & aldosterone)
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| show | considering the abruptness of disease onset
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| Primary AI: abrupt onset: etiology | show 🗑
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| show | Auto-immune Adrenalitis; infxs Adrenalitis; Mets ca; congenital Adrenal Hyperplasia (CAH); Adrenomyeloneuropathy
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| show | Hotn & hypoglycemia. Hyperpigmentation (2/2 XS ACTH). Salt craving; low Na & high K. NAGMA. Vitiligo, pallor. Autoimmune thyroid dz. CNS sx in adrenomyeloneuropathy.
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| Secondary AI (slow onset): etiology | show 🗑
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| AM cortisol results: | show 🗑
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| show | 250 mcg Cosyntropin; measure cortisol before & 30 & 60 min after injxn; pre or post >18: R/O AI
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| Adrenal Insufficiency (AI) labs | show 🗑
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| Adrenal crisis tx | show 🗑
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| show | Hydrocortisone 20mg AM / 10mg PM; Dex; prednisone
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| Tx chronic primary AI: besides cortisol, must also tx insuff of: | show 🗑
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| show | 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)
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| show | Adrenal lesion: exogenous source; Plasma ACTH level is low (< 5 pg/mL)
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| Cushing syndrome: ACTH-dependent: | show 🗑
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| ACTH-dependent Cushing: to distinguish between ectopic & pituitary: | show 🗑
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| Cushing syndrome: tx | show 🗑
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| show | Idiopathic (Familial); PCOS; Androgen-secreting adrenal adenomas or carcinoma; Ovarian tumors; Glucocorticoid resistance
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| Hirsutism / virilization: etiology: ACTH-dependent causes | show 🗑
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| PCOS LH:FSH ratio | show 🗑
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| show | Rare; high serum androgen conc remain elevated despite Dex suppression
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| Androgen-secreting adrenal ca prevalence | show 🗑
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| show | usu > 5 cm at dx; Very high DHEA, DHEA sulfate; No response to HD Dex Suppression
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| show | 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)
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| Hirsutism / virilization: Imaging | show 🗑
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| show | Enzyme defects in adrenal steroid hor synth -> insuff cortisol +/-mineralocorticoid; classically with an assoc androgen excess
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| show | Salt-wasting form; Virilizing Syndromes
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| CAH: nonclassical forms | show 🗑
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| show | 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
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| PCOS Tx options | show 🗑
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| show | Hypertension; Mx Sx (d/t hypokalemia): cramping, weakness, periodic paralysis. Often few clinical sx (Dx from lab abnormalities)
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| show | 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
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| Primary hyperaldosteronism: labs: 18-OH corticosterone | show 🗑
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| Primary hyperaldosteronism: imaging | show 🗑
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| Primary hyperaldosteronism: issues in evaluation | show 🗑
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| Primary hyperaldosteronism: presenting forms | show 🗑
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| show | surgical (effective only in patients with unilateral disease). Angioplasty if RAS.
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| show | Mineralcorticoid receptor antagonists: Spironolactone (DOC) or Eplerenone. CCB. ACEI
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| Pheochromocytoma = | show 🗑
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| show | pain; pallor (ortho hypoTN); palpitations; pressure (HTN); perspiration
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| show | 10% of dz are: extra-adrenal; bilateral; familial; malignant; not assoc w/ HTN
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| Pheochromocytoma: Dx | show 🗑
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| Pheochromocytoma: Med mgmt | show 🗑
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| Pheochromocytoma: Tx of choice | show 🗑
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| show | low levels of corticotropin-releasing factor
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| show | Glucocorticoids only (esp cortisol). Aldosterone normal.
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| show | Adrenal CT. CXR & MRI for ectopic site. DEXA
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| show | decreased protein synthesis, increased protein catabolism, nitrogen wasting, glucose intolerance.
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| show | HTN, Wt gain/central obesity, moon face, buffalo hump, supraclavicular fat pads. Mx weak, fatigue. Poor wound healing, purple striae. Thin hair. Dysmenorrhea. Osteoporosis.
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| show | elevated level suggests lack of physiologic dip
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| show | Transphenoidal microsurgical removal (if proven Cushing dz)
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| show | increased renin (eg, in RAS or renal hypoperfusion like CHF or hypovolemia)
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| Primary hyperaldosteronism MOA | show 🗑
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| Pheochromocytoma patho | show 🗑
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| show | Pheochromocytoma
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| show | MEN (multiple endocrine neoplasia)
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| show | Auto dominant abnormalities -> hyperplasia or neoplasms
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| Types of MEN | show 🗑
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| Wermer syndrome | show 🗑
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| show | Thyroid (medullary carcinoma producing calcitonin), PTH, adrenals (pheo), and Hirschsprung dz
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| show | Measure PTH & Ca levels. Image pancreas & pituitary
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| show | Measure PTH, urinary catecholamines, calcitonin. Image adrenals
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| Sipple syndrome 2b workup | show 🗑
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| show | Cinacalcet
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| Paraneoplastic endocrine syndromes: most common ectopic hormones | show 🗑
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| Paraneoplastic endocrine syndromes: clinical features | show 🗑
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| In pt with high Ca and low PTH, suspect: | show 🗑
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| show | Pituitary adenoma (small basophilic intrasellar tumor). Adrenocortical adenoma (lipid-rich cells in cords). Adrenocortical hyperplasia. Ectopic (lung, thymus, pancreas)
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| show | Epinephrine, norepinephrine, dopamine
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