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28 Cards in this Set
- Front
- Back
What are the 3 zones of the adrenal cortex? what does each zone secrete? |
outer--> inner sweat--> (during) sweet--> sex
1) zona glomerulosa: mineralocorticoid aldosterone |
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what are the causes of adrenal insufficiency ? |
Autoimmune: addison's (MC- 65%) infectious |
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what are the signs and sxs of acute Adrenal Insufficiency? |
signs and sxs: weakness, abdominal pain, fever, HA, confusion, N/V/D. Low BP, dehydration, increased skin pigmentation (extensor surfaces), shock
*similar sx to septic shock!! |
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what would you find in laboratory studies in a pt w/ acute adrenal insufficiency? |
Triad:*** -low BP
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how do you tx acute Adrenal Insufficiency?
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hydrocortisone IV w/ saline infusion |
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T/F You should wait for lab results to being treatment in an adrenal crisis |
FALSE
Treat ASAP!! emergency! |
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what are the signs and symptoms associated w/ chronic adrenal insufficiency? |
arthralgias, myalgias, amenorrhea, sparse axillary hair, incr skin pigmentation (dark spots at birth*)
lab results: elevated eosinophils, hyponatremia & hypoglycemia, hyperkalemia & hypercalcemia elevated BUN, neutropenia, lymphocytosis, mild anemia, low cortisol levels that fail to rise with cortrosyn and elevated ACTH |
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how do you diagnosis chronic adrenal insufficiency? |
Corsyntropin stimulation test (ACTH)--> serum evaluation of cortisol 30-60 min later. Cortisol level should rise at least 20 mcg/dl in normal pt. (Cortisol does NOT rise appropriately) ELevated ACTH in primary AI. Low ACTH in secondary AI
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how do you tx chronic adrenal insufficiency? |
hydrocortisone (maintain for life) |
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Congenital Adrenal hyperplasia results from elevated ACTH This leads to decreased production of ____ & ____ and increased production of ____ & ____ |
decreased--> glucocorticoid & mineral corticoid
increased--> DHEA, androstenedione, progesterone & hydroxyprogesterone |
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4 year old boy presents to your office w/ pubic and axillary hair. You do a blood test and find elevated levels of 17-hydroxyprogesterone, progesterone, DHEA, & androstenedione (converted to testosterone). Dx and tx |
21- hydroxylase deficiency 17-hydroxyprogesterone >1500. ( & > 200 before admin) suppress androgens w/ flutamide (aromatase inhibitor (arimadex) to prevent aromatization of testosterone to estrogen) |
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what is hyporeninemic hypoaldosteronism? what are the sxs? what causes it? tx? |
isolated hypoaldosteronism resulting from decreased renin secretion from the kidneys.
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what is cushing's syndrome? |
isolated hypersecretion of cortisol or exogenous administration. ACTH dependant occurs most often (85%); independent (15%) |
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what three types of tumors secrete ACTH that can cause Cushing's?
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pancreatic, adrenal and thyroid tumors |
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what cancer has a paraneoplastic syndrome that secretes ACTH?
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small cell lung cancer |
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what are the four causes of ACTH independent cushing's? |
adrenal adenomas |
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what is cushing's disease as opposed to cushing's syndrome? |
refers to any cushing's syndrome that is secondary to ACTH producing pituitary tumor only. |
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what are the signs and sxs of cushing's syndrome and disease? |
central obesity, moon facies, buffalo hump, muscle wasting, thin skin, easy bruisability, psychological changes, hirsuitism, striae, amenorrhea
osteoporosis, HTN, hyperglycemia, leukocytosis, hypokalemia poor wound healing |
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what lab findings would be indicative of cushings? |
glucose intolerance |
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how do you dx cushing's? |
dexamethasone suppression test w/ cortisol level drawn at 8 am. Normal <2 mcg/dl
*Find cause |
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what must the pt stop taking in order to accurately diagnose cushings?
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all seizure meds and OCPs |
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what is the tx for cushing's dz?
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remove tumor and then give replacement therapy. or if you can't find the tumor do a b/l adrenalectomy and give an ACTH supressor like ketoconazole, metyrapone or octreotide. |
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What is nelson's syndrome? |
rapidly enlarging pituitary tumor d/t loss of negative feedback from unopposed ACTH production following B/L adrenalectomy. --> causes 3rd nerve palsy
*Tx: pituitary supression (tumor removal) |
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what are the signs and sxs of hyperaldosteronism?
(MC d.t adrenal adenoma) |
HTN, polyuria, polydipsia, muscular weakness, parasthesias, HA, periodic paralysis, hypokalemia, metabolic alkalosis. |
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how do you tx hyperaldosteronism? |
find tumor |
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what does NE cause? epi? dopamine? |
NE: alpha agonist- vasoconstriction
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what is a pheochromocytoma? how does it cause HTN? |
a tumor that is usually in the adrenal medulla (90%), but can be found anywhere along the sympathetic chain (usu mediastinum or abdomen). Causes paroxysmal HTN d/t excessive amounts of plasma NE --> headache, diaphoresis, palpitations --> shock & death |
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how do you tx a pheochromocytoma?
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remove tumor |