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Adrenal 1 Test

Enter the letter for the matching Answer
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1.
ACTH-dependent Cushing: to distinguish between ectopic & pituitary:
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2.
Wermer syndrome workup
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3.
CAH: nonclassical forms
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4.
Primary hyperaldosteronism: presenting forms
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5.
Primary hyperaldosteronism: issues in evaluation
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6.
Tertiary AI etiology
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7.
Adrenal crisis tx
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8.
Recurrent HA, HTN despiteBP meds, sweating, severe HA, glucosuria, abnormal urinary catecholamines & metanephrines =
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9.
ACTH stim test
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CAH: classical forms
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In pt with high Ca and low PTH, suspect:
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Cushing Disease surgery
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AM cortisol results:
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Addison dz: DDx can be narrowed by:
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Pheochromocytoma: Med mgmt
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Hirsutism / virilization: Tx
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Pheochromocytoma; rule of 10
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18.
Paraneoplastic endocrine syndromes: most common ectopic hormones
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19.
Primary hyperaldosteronism MOA
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20.
Tx for aldosterone producing adenoma (APA):
A.
APA (Conn dz, 65%). Bilateral hyperplasia of zona glomerulosa (35%). Primary adrenal hyperplasia. Adrenal carcinoma
B.
High aldosterone -> Na reabsorption -> volume expansion, HTN -> low K (2/2 ion exchange) -> AGMA
C.
ACTH produced by SCLC & other carcinoids. ADH from SCLC, rarely prostate / cervical. PTH-related protein from squamous cell lung ca
D.
low levels of corticotropin-releasing factor
E.
Salt-wasting form; Virilizing Syndromes
F.
Hold aldactone, CCB, ACEI. At least 150mEq of Na intake daily (to suppress aldosterone production)
G.
surgical (effective only in patients with unilateral disease). Angioplasty if RAS.
H.
250 mcg Cosyntropin; measure cortisol before & 30 & 60 min after injxn; pre or post >18: R/O AI
I.
Late-onset: women = hirsutism & menstrual irreg which can mimic PCOS; Men/boy: androgen excess can be asymptomatic
J.
considering the abruptness of disease onset
K.
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
L.
10% of dz are: extra-adrenal; bilateral; familial; malignant; not assoc w/ HTN
M.
>18: r/o AI; <3: R/I AI; btw this range: need dynamic testing
N.
Measure PTH & Ca levels. Image pancreas & pituitary
O.
Transphenoidal microsurgical removal (if proven Cushing dz)
P.
Alpha adrenergic-blockade, then beta-blockade PRN. NEVER beta before alpha (may worsen HTN crises). CCB may be better tolerated than alpha-blockade.
Q.
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)
R.
24h urine free cortisol. CRH-Stimulation test. LD & HD dex suppression. Petrosal sinus sampling. Octreotide scintigraphy to localize ectopic source. MRI
S.
Pheochromocytoma
T.
cancer (paraneoplastic syndrome)
Type the Answer that corresponds to the displayed Question.
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21.
HyperPTH in MEN type 1: tx
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22.
Aldosterone made in:
Type the Question that corresponds to the displayed Answer.
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23.
Thyroid (medullary carcinoma producing calcitonin), PTH, adrenals (pheo), and Hirschsprung dz
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24.
1: Wermer syndrome. 2a: Sipple syndrome. 2b: Sipple tumors w/less preponderance of PTH hyperplasia +marfanoid & multiple neuromas
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25.
Pituitary adenoma (small basophilic intrasellar tumor). Adrenocortical adenoma (lipid-rich cells in cords). Adrenocortical hyperplasia. Ectopic (lung, thymus, pancreas)
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26.
Enzyme defects in adrenal steroid hor synth -> insuff cortisol +/-mineralocorticoid; classically with an assoc androgen excess
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27.
Adrenal CT. CXR & MRI for ectopic site. DEXA
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28.
Epinephrine, norepinephrine, dopamine
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29.
pain; pallor (ortho hypoTN); palpitations; pressure (HTN); perspiration
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30.
Auto dominant abnormalities -> hyperplasia or neoplasms

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