Term
| What is the negative feedback involved in aldosterone release? |
|
Definition
| aldosterone inhibits renin |
|
|
Term
| What are the functions of cortisol? |
|
Definition
maintain CHO, protein, and fat metabolism
maintain physiological integrity of immune and circulatory systems |
|
|
Term
| What is the treatment for Cushing's Disease? |
|
Definition
|
|
Term
| Where does >80% of ectopic ACTH come from? |
|
Definition
|
|
Term
| What is the most common cause of ACTH-INDEPENDENT Cushing's Syndrome? |
|
Definition
| iatrogenic (glucocorticoid use) |
|
|
Term
| How do you treat adrenal nodular(hyperplastic) disease? |
|
Definition
|
|
Term
| Why is adrenal carcinoma so deadly? |
|
Definition
| it has a rapid onset, and the tumor is often metastatic at time of diagnosis |
|
|
Term
| How do you diagnose Cushing's? |
|
Definition
1. 24 hour urinary free cortisol
2. low dose dexamethasone suppression: non-cushing's ACTH production will be inhibited
3. plasma ACTH
4. high dose dexameth; pit cells retain negative fdbck
5. inf petrosal sinus sampling if hypercortisolism is confirmed but cannot differentiate between pit vs ectopic |
|
|
Term
|
Definition
| Physiological states of elevated cortisol (stress, strenuous exercise, pregnancy) or pathologic-mild elevations in cortisol (depression, alcoholism, anorexia) |
|
|
Term
| clinical signs of aldosterone excess |
|
Definition
| HT, dependent edema, hypokalemia, metabolic alkalosis |
|
|
Term
| What is Conn's syndrome, and how do you treat it? |
|
Definition
Aldosterone-producing adrenal adenoma
tx: surigal resection |
|
|
Term
| How do you treat adrenal hyperplasia? |
|
Definition
|
|
Term
| What causes glucocorticoid suppressible hyperaldosteronism, and how do you treat it? |
|
Definition
AD
treat w/glucocorticoids to suppress ACTH, which is what causes the aldosterone secretion |
|
|
Term
| How do you screen for hyperaldosteronism? |
|
Definition
| ratio of plasma aldosterone to renin > 20 is supsicious |
|
|
Term
| How do you confirm hyperaldosteronism? |
|
Definition
| high salt diet (under supervision) for 2-3 days. normal patient will suppress aldosterone secretion |
|
|
Term
| What conditions mimic hyperaldosteronism? |
|
Definition
11-deoxycorticosterone (DOC) tumor
17 hydroxylase deficiency
11 hydroxylase deficiency
cushing's syndrome
11 beta hydroxysteroid dehydrogenase deficiency
exogenous mineralocorticoids
little's syndrome |
|
|
Term
| What happens in 17 hydroxylase deficiency? |
|
Definition
increased production of DOC and aldosterone
presents in puberty
hypertension, hypokalemia, pseudohermaphrodism in males |
|
|
Term
| What happens in 11 hydroxylase deficiency? |
|
Definition
overproduction of DOC
presents in infancy with hypertension, hypokalemia, virilized female (excess androgens) |
|
|
Term
| How does Cushing's syndrome mimic hyperaldosteronism? |
|
Definition
| cortisol acts like aldosterone agonist, and if there is too much, the enzyme that normal deactivates it (11 b hydroxysteroid dehydrog type II) is overwhelmed |
|
|
Term
| What are examples of exogenous mineralocorticoids? |
|
Definition
licorice: glycyrrhizic acid: inhibits 11b hydroxysteroid dehydrogenase
fludrocortisone |
|
|
Term
| What is Little's syndrome? |
|
Definition
a defect in the renal tubules (Na channel constantly activated)
hypertension, hypokalemia |
|
|
Term
| What are the clinical signs of androgen/estrogen excess in females? males? |
|
Definition
females: hirsuitism, muscularity, deepening voice, acne
males: estrogen excess can present w/gynecomastia |
|
|
Term
| What are adrenal causes of sex hormone excess? |
|
Definition
| adrenal carcinoma, cushing's, congenital adrenal hyperplasia |
|
|
Term
| What are clinical signs of acute/chronic glucocorticoid deficiency? |
|
Definition
acute: agitation, fever, abd pain, hypotension, shock, hyponatremia
chronic: malaise, anorexia, orthostatic hypotension, weight loss, hyperpigmentation, hyponatremia |
|
|
Term
| What is the best diagnostic test for glucocorticoid insufficiency? |
|
Definition
1. cosyntropin(ACTH) stimulation test
normal response: cortisol increases
2. measure ACTH |
|
|
Term
| What are the polyglandular autoimmune syndromes? |
|
Definition
cause adrenal insufficiency
type 1: AR, childhood onest, hypoPTH and mucocutaneous candidiasis
type 2: AD (Schmidt's syndrome), adult onset, DM I and autimmune thyroid disease |
|
|
Term
| What are the clinical signs of mineralocorticoid deficiency? |
|
Definition
| hyponatremia, hyperkalemia, cardiac arrhythmias, muscle weakness |
|
|
Term
| How do you treat mineralocorticoid deficiency? |
|
Definition
|
|
Term
| What is really high in 21 hydroxylase deficiency? |
|
Definition
| 17 OH progesterone (the product before the block) |
|
|
Term
| What are the 5p's of pheochromocytoma? |
|
Definition
| pressure, pain, persipiration, palpitations, pallor |
|
|
Term
| What is the rule of tens assoc w/pheochromocytoma? |
|
Definition
| 10% extra-adrenal, familial, multiple/bilateral, malignant, recur, children, incidentally discovered |
|
|
Term
| How do you diagnose pheochromocytoma? |
|
Definition
1. 24 hour urine collection: catecholamines and metanephrines
if epi >15%, tumor is intraadrenal because cortisol is required to convert NE to EPI
2. MRI or MIBG scan |
|
|
Term
| What can cause false positives in the urine test for catecholamines? |
|
Definition
| tricyclic antidepressants, levodopa, amphetamines, anti-psychotics, clonidine withdrawal, major physical stress |
|
|
Term
| How do you treat pheochromocytoma? |
|
Definition
| alpha blocker 10-14 days before surgery (prevent paradoxical rise in BP), b blocker 2-3 days before |
|
|
Term
| What do you when you find an adrenal incidentaloma? |
|
Definition
screen for pheo and cushing's
if hypertensive, screen for hyperaldost |
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