Term
| Describe the hypothalamic axis, target organ and its effect on that organ for ACTH. |
|
Definition
| The hypothalamus secretes CRH (corticotropin-releasing hormone) which tells the anterior pituitary to secrete ACTH which goes to the adrenal cortex and causes the secretion of androgens and cortisol from the cortex. |
|
|
Term
| Describe the hypothalamic axis, target organ and its effect on that organ for TSH. |
|
Definition
| The hypothalamus secretes TRH (thyrotropin-releasing hormone) which tells the anterior pituitary to secrete TSH which goes to the thyroid gland and causes the secretion of T3 and T4. |
|
|
Term
| Describe the hypothalamic axis, target organ and its effect on that organ for GH. |
|
Definition
| The hypothalamus secretes GHRH (growth hormone releasing hormone) which tells the anterior pituitary to secrete GH which goes to the liver, bone, muscle and adipose to promote growth and lipid/carbohydrate metabolism. |
|
|
Term
| Describe the hypothalamic axis, target organ and its effect on that organ for PRL. |
|
Definition
| Normally the hypothalamus secretes dopamine which inhibits the release of PRL, during breastfeeding this inhibitory hormone is not secreted and PRL acts on the mammary glands to stimulate milk production. |
|
|
Term
| Describe the hypothalamic axis, target organ and its effect on that organ for FSH. |
|
Definition
| The hypothalamus secretes GnRH (gonadotropin-releasing hormone) which tells the anterior pituitary to secrete FSH which goes to the testes in men, secreting inhibin and the ovaries in women, secreting estrogen and inhibin. |
|
|
Term
| Describe the hypothalamic axis, target organ and its effect on that organ for LH. |
|
Definition
| The hypothalamus secretes GnRH (gonadotropin-releasing hormone) which tells the anterior pituitary to secrete LH which tells the testes to secrete testosterone and the ovaries to produce progesterone. |
|
|
Term
| Describe the hypothalamic axis, target organ and its effect on that organ for Oxytocin. |
|
Definition
| The hypothalamus makes oxytocin and transports it to the posterior pituitary where it is secreted, it can go to the uterus and cause contractions, to the breast to cause "milk letdown" and to the prostate which causes smooth muscle contraction. |
|
|
Term
| Describe the hypothalamic axis, target organ and its effect on that organ for ADH (Anti-diuretic hormone). |
|
Definition
| The hypothalamus secretes a preprohormone of ADH that goes to the posterior pituitary and is secreted as ADH which travels to the kidneys to stimulate water retention and raise BP by contracting arterioles. |
|
|
Term
| Describe the feedback system for oxytocin. |
|
Definition
| It is one of the few positive feedback systems in the body as suckling by an infant on the mothers breast causes more oxytocin to be released. |
|
|
Term
| Describe the feedback system for Prolactin. |
|
Definition
| It is not positive or negative feedback but it has a constant supply of its inhibitory hormone (Dopamine) but just after childbirth dopamine levels drop and PRL levels begin to rise. |
|
|
Term
| What hormone is responsible for GH inhibition? |
|
Definition
| GHIH - Growth hormone-inhibiting hormone (Somatostatin) |
|
|
Term
| What results from hypersecretion of GH in children? Adults? Hyposecretion in children? |
|
Definition
Hyper in children = gigantism.
Hyper in adults = acromegaly.
Hypo in chidlren = pituitary dwarfism. |
|
|
Term
| What are the most common congenital hypothalamic diseases? |
|
Definition
| The most common congenital hypothalmus disorders are the midlien cleft syndromes of, most commonly, the optic and olfactory tracts, the septum pellucidum, the corpus collosum, the anterior commissure , the hypothalamus and the pituitary. |
|
|
Term
| What is the most common type of neuroendocrine tumor? |
|
Definition
|
|
Term
| Describe the excess hormone produced and the disorder associated with a somatotrophic neuroendocrine tumor. |
|
Definition
| GH is produced and can lead to gigantism or acromegaly. |
|
|
Term
| Describe the excess hormone produced and the disorder associated with a lactotrophic neuroendocrine tumor. |
|
Definition
| Prolactin is produced and can lead to hypogonadism and galactorrhea (milky nipple discharge unrelated to the normal milk production of breast-feeding). |
|
|
Term
| Describe the excess hormone produced and the disorder associated with a corticotrophic neuroendocrine tumor. |
|
Definition
| ACTH is produced and it can lead to Cushing's disease. |
|
|
Term
| Describe the excess hormone produced and the disorder associated with a gonadotrophic neuroendocrine tumor. |
|
Definition
| FSH and LH are produced and can lead to hypopituitarism and other mass effects. |
|
|
Term
| Describe the excess hormone produced and the disorder associated with a thyrotrophic neuroendocrine tumor. |
|
Definition
| TSH is produced and can lead to hyperthyroidism. |
|
|
Term
| What are some common S&S to neuroendocrine tumors? |
|
Definition
| It depends on the type of tumor but headache, nausea, vomiting, altered consciousness, visual field defects and seizures are common. |
|
|
Term
| What are the effects of hyperprolactinemia in women? Men? |
|
Definition
Women = oligomenorrhea (infrequent menstruation), amenorrhea, galactorrhea (milky nipple discharge unrelated to childbirth) and infertility.
Men = hypogonadism, decreased libido, ED and infertility. |
|
|
Term
| What tests are diagnostic of hyperprolactinemia? |
|
Definition
| Elevated serum PRL and an MRI/CT showing a pituitary adenoma. |
|
|
Term
| What are some physiologic causes of hyperprolactinemia? |
|
Definition
| Exercise, pregnancy, breast feeding, nipple stimulation and stress (trauma/surgery). |
|
|
Term
| What are some pharmacologic causes of hyperprolactinemia? |
|
Definition
| Amphetamines, Cimetidine, Ranitidine, Estrogens, Opioids, Nicotine, Verapamil and Cocaine. |
|
|
Term
| What are some pathologic causes of hyperprolactinemia? |
|
Definition
| Chronic chest wall stimulation, cirrhosis, renal failure, hypothyroidism, MS, spinal cord lesion and SLE. |
|
|
Term
| What are the pharmacologic treatment options for hyperprolactinemia? (w/ max dose) |
|
Definition
| Cabergoline (Dostinex) is first line and best tolerated. Max dose is 1.5 mg 2x/week. Bromocriptine used to be first line but is not any longer. |
|
|
Term
| What are the surgical indications for hyperprolactinemia due to a pituitary adenoma? |
|
Definition
| Intolerance to medical treatment, headaches, visual field defects, CSF leakage due to tumor or a central nervous system deficit. |
|
|
Term
| What is the class, indication, dose, SEs, interactions, contraindications, OD and patient education for Synthroid (levothyroxine)? |
|
Definition
Class = Synthetic T4.
Indication = Hypothyroidism.
Dose = 1.6 mcg/kg/day, increase at 6 weeks if needed (increase by 25 mcg).
SEs = heat intolerance, weight loss, fever, sweating, tachycardia, decreased bone density (hyperthyroidism SEs).
Interactions = Amiodarone, iron and calcium supplements, hypoglycemic agents.
Contraindications = acute MI, adrenal insufficiency, thyrotoxicosis.
OD = Hyperthyroidism effects.
Pt Education = Do not discontinue or change medication. Do not use as weight loss agent. Do not take food 4 hours before or after taking pills. |
|
|
Term
| What is the class, indication, dose, SEs, interactions, contraindications, OD and patient education for Tapazole (methimazole)? |
|
Definition
Class = Thiourea.
Indication = Hyperthyroidism.
Dose = 5-15 mg/day (divided into 3 doses).
SEs = epigastric distress, loss of hair, skin pigmentations and jaundice.
Interactions = anticoagulants, digoxin, thiophylline and BBs.
Contraindications = nursing mothers.
OD = headache, fever, joint pain, edema and aplastic anemia.
Patient education = Come see me if you have fever/sore throat. |
|
|
Term
| What is the class, indication, dose, SEs, interactions, contraindications, OD and pt education for Zometa (zoledronic acid)? |
|
Definition
Class = Bisphosphonates.
Indications = malignant hypercalcemia, multiple myeloma and osteoporosis (but not hypercalcemia due to hyperparathyroidism).
Dose = 4mg/5ml IV x every month infused over at least 15 minutes. (must check calcium and renal function before infusion).
SEs = fever.
Contraindications = Renal impairment.
Pt education = do not get pregnant.
Look up OD - |
|
|
Term
| What is the class, indication, dose, SEs, interactions, contraidications and pt education for Solu-Cortef (hydrocortisone sodium succinate)? |
|
Definition
Class = Corticosteroids.
Indication = adrenal insufficiency.
Dosage = 20-240 mg po daily.
SEs = vision loss, weight gain, depression, insomnia, thinning of the skin, slow wound healing, immunosupression, increased risk of osteoporosis.
Interactions = aspirin, rifampin, coumadin and ketoconazole.
Contraindication = any type of infection and live vaccines.
Patient education = immunosupression so come in if they get sick. |
|
|
Term
| What is the class, indication, dose, SEs, interactions and contraindications for Inderal (propranolol)? |
|
Definition
Class = Beta blockers.
Indication = Pheochromocytoma.
Dosage = 60 mg/day PO divided bid/tid.
SEs = CHF, heart block, bradycardia, bronchoconstriction.
Interactions = Amiodarone, lidocaine and alcohol.
Contraindications = asthma, must include alpha blocker too, angina/MI.
Pt education - no alcohol. |
|
|
Term
| Describe hypopituitarist and what is lost. |
|
Definition
| Loss of one, all or any combination of anterior pituitary hormones (ACTH, TSH, LH, FSH, GH, PRL). |
|
|
Term
| What is Sheehan's syndrome? What are teh typical S&S? |
|
Definition
| Acquired hypopituitarism due to trauma to the head or post-partum. Sx appear months to years later and include: adrenal crisis, hypothyroidism, hypotension, amenorrhea, inability to breastfeed and high cholesterol. |
|
|
Term
| What are the signs and symptoms of LH/FSH deficiency hypopituitarism? |
|
Definition
| hypogonadism, infertility, delayed puberty, decreased body hair, decreased libido, amenorrhea, & erectile dysfunction |
|
|
Term
| What are the S&S of ACTH deficiency hypopituitarism? |
|
Definition
| weakness, fatigue, weight loss & hypotension |
|
|
Term
| What are the adult S&S of GH deficiency hypopituitarism? |
|
Definition
| moderate central obesity, increased systolic BP, increased LDL cholesterol, small heart, growth retardation |
|
|
Term
| What are the general S&S seen with most hypopituitarism deficiencies? |
|
Definition
| Headache and visual field defects/blindness. |
|
|
Term
| What are the treatments for hypopituitarism due to a tumor? |
|
Definition
| Replace the hormone and remove the tumor. |
|
|
Term
|
Definition
| Low growth hormone levels during development. |
|
|
Term
| What are some common complication due to dwarfism? |
|
Definition
| Delay in motor skill development, frequent ear infections, hearing loss, sleep apnea, crowded teeth, kyphoscoliosis, lumbosacral spinal stenosis and arthritis. |
|
|
Term
| What is the treatment and management of dwarfism? |
|
Definition
| Refer to endocrinology/orthopedic for GH replacement and possibly surgical intervention for bone abnormalities. |
|
|
Term
| What are the common S&S of Acromegaly/Gigantism? |
|
Definition
| Excessive growth of hands, feet, jaw & internal organs, amenorrhea, headache, visual field defects, hypertension, impotence, widening of tooth spaces, deep voice, goiter, hypothyroidism, dilated left ventricle, weakness and soft/doughty/sweaty handshake. |
|
|
Term
| What biomarker is commonly used to test for acromegaly/gigantism? |
|
Definition
| IGF-1 (insulin-like growth factor - 1) |
|
|
Term
| What are some complications of acromegaly/gigantism? |
|
Definition
| HTN, DM, cardiac enlargement, carpal tunnel syndrome, thumb weakness, visual field defects, cranial nerve palsies, and colon polyps. |
|
|
Term
| Describe the treatment and management of a patient with acromegaly/gigantism. |
|
Definition
| Referral to endocrinology or cardiology (if cardiac symptoms), surgical removal of the adenoma and give Cabergoline (blocks PRL production) and Octreotide (acts like somatostatin). |
|
|
Term
| What is the difference between Cushing's disease vs. syndrome? |
|
Definition
| Disease is caused by a pituitary adenoma that causes excess ACTH secretion. Syndrome is any cause of excess glucocorticoid. |
|
|
Term
| What are the S&S of Cushing's disease? |
|
Definition
| obesity, moon face, buffalo hump, purple striae, hypertension, skin hyperpigmentation, hirsuitism, proximal muscle weakness, DM, headache and visual field defect. |
|
|
Term
| What electrolyte disturbances are seen with Cushing's disease? |
|
Definition
| Hypokalemia and hypercalciuria. |
|
|
Term
| What are some complications of Cushing's disease? |
|
Definition
| Cushing's syndrome, HTN, DM, increased risk of infection, osteoporosis and visual field impairment. |
|
|
Term
| Describe the treatment and management of Cushing's disease. |
|
Definition
| Referral to endocrinology, surgical excision of adenoma, consider discontinuation of excessive corticosteroid use, may need potassium supplements. |
|
|
Term
| What is Nelson's syndrome? |
|
Definition
| It is the appearance of a pituitary adenoma after bilateral adrenalectomy for Cushing's disease/syndrome due to the elimination of negative feedback of cortisol, greatly increasing ACTH and MSH. |
|
|
Term
| What are the S&S of Nelson's syndrome? |
|
Definition
| Very high levels of ACTH, hyperpigmentation (increased MSH), headache and visual field loss. |
|
|
Term
| What is the treatment for Nelson's syndrome? |
|
Definition
| Surgery if adenoma and glucocorticoids (hydrocortisone). |
|
|
Term
| Describe central DI, nephrogenic DI and gestational DI. |
|
Definition
Central DI is inadequate secretion of vasopressin.
Nephrogenic DI is insensitivity to vasopressin.
Gestational DI is a lack of ADH due to an enzyme breakdown during pregnancy. |
|
|
Term
| What are the common clinical signs and symptoms of DI? |
|
Definition
| ADH deficiency (not nephrogenic though), polyuria, polydipsia, nocturia, hypernatremia, dehydration, headache, visual disturbances. |
|
|
Term
| What are some common risk factors for diabetes insipidis? |
|
Definition
| Transcranial surgery, head trauma w/ basal skull fracture, lithium use and a neoplasm. |
|
|
Term
|
Definition
| Water restriction test and MRI/CT. |
|
|
Term
| What are some complication of DI? |
|
Definition
| Dilated urinary tract and dehydration leading to confusion, stupor and coma. |
|
|
Term
What is the first line Tx for DI?
What else can be used? |
|
Definition
| Desmopressin/DDAVP). Can also use Chlorpropamide/Diabinese and HCTZ. |
|
|
Term
| What are the common S&S of hyperparathyroidism? |
|
Definition
| Hypercalcemia, bone pain, pathologic fractures, mental changes, fatigue, constipation, HTN w/ shortened QT interval, renal stones, polyuria, polydipsia. |
|
|
Term
| Explain the changes in serum calcium, serum alkaline phosphate, urine calcium and urine phosphate seen with elevated PTH levels. |
|
Definition
|
|
Term
| What are the common risk factors of hyperparathyroidism? |
|
Definition
| Age over 50, female, chronic lithium therapy and history of neck radiation. |
|
|
Term
| How will hyperparathyroidism appear on labs? |
|
Definition
| High serum calcium, low serum phosphate, low vitamin D, elevated PTH. |
|
|
Term
| What are some common complications of hyperparathyroidism? |
|
Definition
| UTI, renal stones, renal failure, pathologic fractures and HTN. |
|
|
Term
| What is the treatment for Hyperparathyroidism? |
|
Definition
| IV hydration, furosemide (Loop diuretic), alendronate (Bisphosphonates), cinacalcet (Calcimimetics) and surgery to remove the diseased gland. |
|
|
Term
| What are some common S&S of hypoparathyroidism? |
|
Definition
| Tetany, carpopedal spasms, muscle and abdominal cramps, brittle nails, loss of eyebrow hair, postive Chvostek's sign and Trousseau's phenomenon. |
|
|
Term
| Describe the electrolyte abnormalities seen with hypoparathyroidism. |
|
Definition
| low serum calcium and magnesium and high serum phosphate. |
|
|
Term
| What are the common risk factors of hypoparathyroidism? |
|
Definition
| Thyroidectomy (MC), neck surgery, neck trauma and neck malignancies. |
|
|
Term
| What does hypoparathyroidism look like on x-ray? |
|
Definition
| Increased bone density and calcification of the cerebellum and choroid plexus. |
|
|
Term
| What is the formula for corrected serum calcium? |
|
Definition
| Serum calcium mg/dL + [0.8 x (4.0 - albumin g/dL)] |
|
|
Term
| What are some complications of hypoparathyroidism? |
|
Definition
| Neuromuscular symptoms, cataracts, hypothyroidism, Parkinsonian symptoms and permanent mental damage. |
|
|
Term
| What is the treatment for hypoparathyroidism? |
|
Definition
| Treat the cause of the tetany, IV calcium gluconate (until tetany ceases), calcium salts, Vitamin D and calcitriol. |
|
|
Term
| What is Paget's disease and how is it differentiated from hyperparathyroid? |
|
Definition
| A chronic disorder of the adult skeleton in which bone turnover is accelerated, normal bone is replaced with softened, less dense, enlarged bone. It is differentiated from hyperparathyroid bc Paget's will have normal serum calcium, phosphate and PTH and a markedly elevated alkaline phosphate. Hyperparathyroidism will have an elevated serum calcium and PTH, a low serum phosphate and a normal alkaline phosphate. |
|
|
Term
| What are the common S&S of hyperthyroidism? |
|
Definition
| sweating, diarrhea, heat intolerance, warm/moist skin, tremors, menstrual irregularity, tachycardia, goiter, exopthalmos. |
|
|
Term
| What is usually the first presenting sign of hyperthyroidism in an elderly patient? |
|
Definition
|
|
Term
| How will hyperthyroidism appear on labs? |
|
Definition
| low TSH and elevated T3/T4. |
|
|
Term
| What is the treatment for hyperthyroidism? |
|
Definition
| Refer to endocrinology, remove adenoma, antithyroid meds (Propylthiouracil), and possible ablation with I-131. |
|
|
Term
| What is the most common cause of thyrotoxicosis? |
|
Definition
|
|
Term
| What is the etiology of Graves disease? |
|
Definition
| Autoimmune disorder of the thyroid where the TSH receptors are stimulated by TSI antibodies. |
|
|
Term
| What conditions are associated with Graves disease? |
|
Definition
| pernicious anemia, myasthenia gravis and DM. |
|
|
Term
| What is the treatment for Graves disease? |
|
Definition
| refer to endocrinology, propranolol, thiourea drugs (methimazole or propylthiouracil), radioactive iodine (I-131) and thyroid surgery. |
|
|
Term
| Describe Hashimoto's thyroiditis. Who is it common with? |
|
Definition
| Transient autoimmune hypothyroidism due to attack of the gland by TPO or thyroglobulin autoantibodies. Common in postpartum patients. |
|
|
Term
| What is a thyroid storm? S&S? |
|
Definition
| Extreme form of thyrotoxicosis that is a medical emergency and has a high mortality rate. S&S = marked delirium, severe tachycardia, vomiting, diarrhea, dehydration and very high fever. |
|
|
Term
| What is the treatment for a thyroid storm? |
|
Definition
| Thiourea (methimazole), propylthiouracil, propranolol, hydrocortisone and discontinue all aspirin. |
|
|
Term
| What are the S&S of hypothyroidism? |
|
Definition
| cold intolerance, constipation, monorrhagia, bradycardia, delayed DTRs, dry skin, coarse voice, enlarged heart, reduced systolic BP, carpel tunnel syndrome, macroglossia, arthralgias and weight gain. |
|
|
Term
| What are the risk factors for hypothyroidism? |
|
Definition
| Increasing age, autoimmune disease, previous postpartum thyroiditis and previous head/neck/breast radiation. |
|
|
Term
| How will TSH, T4, serum cholesterol, serum sodium, CPK, LDH and AST (Aspartate aminotransferase) be affected by hypothyroidism? |
|
Definition
| TSH will be elevated, T4 will be decreased, cholesterol will be elevated, sodium will be decreased and CPK,LDH and AST will be elevated. |
|
|
Term
| What is the treatment for hypothyroidism? |
|
Definition
| First line is Levothyroxine (synthroid). |
|
|
Term
| What is the treatment for Sheehan's syndrome? |
|
Definition
| Replace whatever they are deficient in (Synthroid, Hydrocortisone, Estrogen/Progesterone, GH...etc). |
|
|
Term
| What are the typical S&S of Hashimoto's thyroiditis? |
|
Definition
| Enlarged thyroid that is firm and finely nodular, dry mouth and eyes, hyperthyroid symptoms and then hypothyroid symptoms. |
|
|
Term
| What are the risk factors for Hashimoto's Thyroiditis? |
|
Definition
| Autoimmune diseases, dietary iodine supplements, amiodarone and head/neck radiation. |
|
|
Term
| What biomarkers are useful in diagnosing Hashimoto's Thyroiditis? |
|
Definition
| TPO and thyroiglobulin autoantibodies |
|
|
Term
| What are the complications of thyroiditis? |
|
Definition
| If left untreated it may progress to hypothyroidism. |
|
|
Term
| What is the workup for a thyroid nodule? |
|
Definition
| Thyroid function test, thyroid biopsy (definitive), ultrasound and mandatory foll-up. |
|
|
Term
| What are some common S&S with thyroid nodules? |
|
Definition
| Goiter, hoarseness, dysphagia, hyper- or hypo-thyroidism. |
|
|
Term
| What labs should you order with a unknown thyroid nodule? |
|
Definition
| First order a TSH/FT4, also order TPO and thyroglobulin autoantibodies, possible US with FNA and RAI uptake test. |
|
|
Term
| Do soft or firm thyroid nodules have a higher suspicion of being malignant? |
|
Definition
|
|
Term
| Do "hot" or "cold" RAI uptake test results have a higher suspicion of being malignant? |
|
Definition
|
|
Term
| Do cystic or solid lesions have a higher suspicion of being malignant? |
|
Definition
|
|
Term
| If a thyroid mass gets larger or small with thyroxine suppression therapy, which is it more suspicious of being malignant? |
|
Definition
|
|
Term
| How will neoplastic thyroid diseases appear on thyroid function tests? RAI thyroid scan? How are they definitively diagnosed? |
|
Definition
| They will be normal on TFT. They will show a "cold" nodule on thyroid scan. They are definitively diagnosed by a positive FNA. |
|
|
Term
| What are the S&S for a neoplastic thyroid disease? |
|
Definition
| Palpable, firm, nontender thyroid nodule, asymptomatic, neck discomfort, dysphagia and hoarseness. |
|
|
Term
| What type of thyroid neoplasm is the most common? Lowest death rate? Highest death rate? |
|
Definition
Most common = Papillary.
Lowest death rate = Papillary.
Highest death rate = Anaplastic. |
|
|
Term
| What is the 5 year survival rate for papillary thyroid carcinomas for stage 1-4 TNM staging? |
|
Definition
1 = 99%.
2 = 99%.
3 = 95%.
4 = 80% (any T any N any M). |
|
|
Term
| What test diagnoses Cushing's syndrome? |
|
Definition
| Dexamethasone suppression test. |
|
|
Term
| What are the S&S of acute adrenal insufficiency (Addisonian crisis/Adrenal crisis)? |
|
Definition
| Headache, weakness, abdominal pain, fever, confusion, nausea, vomiting, diarrhea, dehydration, low BP, hypoglycemia and increased skin pigmentation. |
|
|
Term
| How are serum potassium, sodium and BUN affected with acute adrenal insufficiency/Addisonian crisis? |
|
Definition
| Serum potassium is elevated, sodium is low and BUN is elevated. |
|
|
Term
| What are the risk factors for acute adrenal insufficiency (Addisonian crisis)? |
|
Definition
| Stress, bilateral adrenalectomy and sudden destruction of the pituitary. |
|
|
Term
| What is the treatment for acute adrenal insufficiency (Addisonian crisis)? |
|
Definition
| Send to the ER, admit the patient, call endocrinology, give Hydrocortisone and possible broad spectrum antibiotics and monitor electrolytes, BUN and creatinine. |
|
|
Term
| What are the risk factors for Addison's disease? |
|
Definition
| Family history of autoimmune adrenal insufficiency and chronic use of steroids. |
|
|
Term
| What are the S&S of chronic primary adrenal insufficiency (Addison's disease)? |
|
Definition
| Weakness, weight loss, nausea, vomiting, diarrhea, muscle pain, joint pain, amenorrhea, increased skin pigmentation, hypotension, small heart, decreased cold tolerance, salt craving and orthostatic hypotension. |
|
|
Term
| How will Addison's disease present with respect to cortisol levels, ACTH levels and serum sodium/potassium/calcium/BUN levels? |
|
Definition
Cortisol levels = low.
ACTH levels = high.
Sodium = low.
Potassium = high.
Calcium = high.
BUN = high. |
|
|
Term
| What is the treatment for Addison's disease? |
|
Definition
| Refer to endocrinology, hydrocortisone, fludrocortisone and dehydroepiandrosterone. |
|
|
Term
| How will secondary adrenal insufficiency present in respect to ACTH, cortisol, aldosterone, serum sodium and potassium? Why? |
|
Definition
| ACTH is decreased due to damage to the anterior pituitary so that results in a decrease in cortisol secretion. Aldosterone is normal though due to compensation of the RAAS. Sodium and potassium are normal. |
|
|
Term
| What are the S&S of hyperaldosteronism (Conn's disease)? |
|
Definition
| HTN, polyuria, polydipsia, muscular weakness, and headache. |
|
|
Term
| How does Hyperaldosteronism (Conn's disease) effect serum potassium, sodium and renin? |
|
Definition
| Hypokalemia, hypernatremia and low plasma renin. |
|
|
Term
| How is hyperaldosteronism (Conn's disease) diagnosed? |
|
Definition
| 24 hour urine aldosterone over 20 mcg and adrenal tumor seen on CT. |
|
|
Term
| How will secondary hyperaldosteronism appear on labs (serum renin/aldosterone/sodium/potassium)? |
|
Definition
| Renin will be increased, aldosterone will be increased, sodium will be increased and potassium will be decreased. |
|
|
Term
| What are the risk factors for hypoaldosteronism? |
|
Definition
| Over 45 years old, chronic renal disease, diabetes, and meds (NSAIDS, ACEi's and diuretics). |
|
|
Term
| What are the S&S of hypoaldosteronism? |
|
Definition
| Postural hypotension, anorexia and weight loss. |
|
|
Term
| How will hypoaldosteronism be seen on labs (24 hr urine aldosterone, serum potassium, sodium and renin)? |
|
Definition
| 24 hr urine aldosterone will be low. Hyperkalemia, hyponatremia and elevated plasma renin. |
|
|
Term
| What is the treatment for hypoaldosteronism? |
|
Definition
| Consult nephrologist, Fludrocortisone and increase their salt intake. |
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|
Term
| What are the S&S of a pheochromocytoma? |
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Definition
| Attacks of headaches, perspiration, palpitations and anxiety, and HTN. |
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Term
| How will a pheochromocytoma affeect serum glucose, calcium, and urine catecholamines? |
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Definition
| Hyperglycemia, hypercalcemia and increased urine catecholamines. |
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Term
| What are the risk factors for a pheochromocytoma? |
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Definition
| Family Hx of pheochromocytoma, MEN type IIa/b and NF1. |
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Term
| What lab findings are diagnostic of a pheochromocytoma? |
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Definition
| Elevated 24 hour urine VMA and catecholamines with an abdominal MRI showing an adrenal medulla tumor. |
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Term
| What is the treatment of a pheochromocytoma? |
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Definition
| Surgery to remove tumor and alpha/beta blockers. |
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