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Flashcards in adrenal diseases Deck (29)
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1
Q

What would you think if a female patient presents with hypertension, central obesity and purple striae?

A

Cushings

2
Q

What is the most common screening tool for cushings?

A

1mg overnight dexamethasone suppression test– 1 mg dex at 11PM, 8AM cortisol level- <2mcg/dl is normal

3
Q

What are two other screening tests for cortisol?

A

24 hour urine free cortisol level

Midnight salivary cortisol level

4
Q

What do you think when you see hypertension with hypokalemia?

A

hyperaldosteronism

5
Q

What are the two etiologies of hyperaldosteronism?

A

adenoma or bilat hyperplasia

6
Q

What is a positive screening test for hyperaldosteronism?

A

aldosterone/renin ratio >30 with pt not taking diuretics, beta blockers, nifedipine

7
Q

What are the two localizing tests used to identify the cause of hyperaldosteronism?

A

CT scan- sensitive but not specific since nodules are common in patients >40 years old Bilateral adrenal vein sampling- aldo/cort Iodocholesterol scans

8
Q

What are the treatments for hyperaldosteronism?

A

Surgical– laparoscopic adrenalectomy Medical– spironolactone, amiloride, epleronone

Side note: spironolactone causes gynecomastia

9
Q

Hypertension with abdominal bruit?

A

renal artery stenosis

10
Q

what does renal artery stenosis lead to?

A

secondary hyperaldosteronism

11
Q

In secondary hyperaldosteronism, is renin high or low?

A

high! As opposed to primary where it is low compared to aldosterone (30:1)

12
Q

Hypertension with Headaches, Sweats, and Palpitations?

A

pheochromocytoma

13
Q

are a-receptors more sensitive to norepi or epi? What does this cause internally?

A

NE > Epi

Arteriolar constriction
Sweating

14
Q

are b-receptors more sensitive to norepi or epi? What does this cause internally?

A

EPI > Norepi

Arteriolar dilatation
increased contractility / rate
increased BG (blood glucose)

15
Q

What will you see in more than 98% of people with pheochromocytoma?

A

a change in blood pressure….could be in the form of the following:
Sustained HTN
Paroxysmal HTN
Orthostatic change
Paradoxal change in BP:from b-blockers, anesthesia

16
Q

what are some other signs?

A

Tachycardia / Arrhythmia / CHF / Shock

Facial pallor / tremor

17
Q

what is the most common screening test for pheochromocytoma?

A

24 hour urine catechols, . metanephrines, or VMA

18
Q

What are two other screening tests?

A

Plasma fractionated metanephrine

Clonidine suppresion test

19
Q

what are localizing tests for pheochromocytoma?

A

MRI (best) or CT

MIBG Scan- nuclear medicine test

20
Q

What do you administer pre-op for pheochromocytoma?

A

Selective a1 –blockade: Doxazosin & Prazosin

Less reflex tachycardia
Shorter T½
Less postoperative hypotension

21
Q

What is the most common cause of Addison’s disease? other causes?

A

autoimmune disorder- most common but still very rare

Tuberculosis
HIV, CMV
Ketoconazole rx
Adrenal hemorrhage– heparin, meningococcemia

22
Q

In Addison’s disease, of the following, which will increase and which will decrease? Cortisol, ACTH, aldosterone, K+, Na+, b.p.

A

cortisol (dec.) ACTH (inc.) aldosterone (dec.) K+ (inc.) Na+ (dec.) b.p. (dec.)

23
Q

what are some other autoimmune diseases seen with Addison’s disease?

A

vitiligo, hypothyroidism, pernicious anemia, type 1 diabetes, hypoparathyroidism

24
Q

What test is used to diagnose Addison’s disease?

A

Cortrosyn stimulation test—to test how well adrenals respond to ACTH administration. subnormal cortisol level at 30 minutes («18 mcg/dl

25
Q

What are the treatments for Addison’s disease?

A

Prednisone 5/2.5 or cortisone 25/12.5
Fludrocortisone 0.1 mg qd
Increased steroids during severe stress– hydrocortisone 100 mg IV q8h

26
Q

Are adrenal masses common as incidental findings on CT, MRI, echo?

A

yes

27
Q

What are the four possibilities you are thinking if you find an adrenal incidentaloma?

A

adrenal adenoma, adrenal carcinoma, pheo, metastasis

28
Q

when would you biopsy an incidentaloma?

A

If the pt. has another known primary tumor to r/o metastases

29
Q

when would surgery be indicated?

A

if the mass is >4 cm or enlarging