Term
| How does Aldosterone affect renin levels |
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Definition
| Decreases the release of renin |
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Term
| What is the first think you should check when suspecting an ACTH-Independant Cushing's Lesion |
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Definition
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Term
| How do you work up a patient suspected of Cushing's |
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Definition
A) 24-hr Free cortisol,
Alts: Late night Cortisol, Low dose Dexamethasone suppression(night)
B)Plasma ACTH
1)ACTH Dep: Pituitary/Chest imaging
2)ACTH Indep: Abdominal Imaging |
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Term
| What are some tests to discern the cause of a ACTH-dependant cushing's patient if the imaging studies are inconclusive |
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Definition
High Dose Dexamethasone(Pituitary has more Negative feedback)
Petrosal Sinus Sampling(Ratio of petrosal to plasma ratio >3 suggests Pituitary) |
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Term
| What is the treatment for a cushing's patient with Nodular Adrenal Disease |
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Definition
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Term
| What are some signs of mineralocorticoid excess? |
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Definition
Edema
HPTN
Hypokalemia
Metabolic Acidosis
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Term
| What is the cause and treatment of glucocorticoid supressible hyperaldosteronism |
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Definition
Auto Dom disorder of adrenal cortex releasing aldosterone in response to ACTH levels
Treatment: Corticosteroids |
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Term
| How would you work up a patient suspected of Mineralcorticoid excess |
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Definition
Plasma Aldosterone/Renin Ratio(>20 suggestive of excess
High Salt Diet to confirm
Image Adrenals
Inconclusive imaging lends Renal vein Sampling |
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Term
| What are some common disorders that mimic mineralcorticoid excess and their mechanism |
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Definition
DOC tumor
17 alpha Hydroxylase: Increased DOC
11B Hydroxylase: Increased DOC
11B Hydroxysteroid Dehydrogenase Type II or Cushing's: Aldosterone Agonist
Little's Syndrome: Hyperacive EnAC
Exogenous Mineralcorticoids: Licorice/Fludrocortisone
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Term
| How do you screen for Adrenal insufficiency? What signs beyond screening would suggest Primary versus secondary adrenal insufficiency |
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Definition
Cosyntropin Stimulation Test
Measure ACTH
Hyperpigmentation and Hypokalemia is usally specific to Primary Adrenal Insufficiency |
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Term
| What is the most common cause of adrenal insuffieciency world wide and in the US |
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Definition
US: Addison's
World Wide: TB |
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Term
| What would be the cause of low ACTH levels but a Cosyntropin response in a patient? |
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Definition
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Term
| What is the treatment of Glucocorticoid Deficiency |
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Definition
Acute: High does Steroids
Stable: Maintainence Steroids
Primary: Mineralcorticoids and Corticosteroids |
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Term
| What are some treatment options for Mineralocorticoid Deficiency |
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Definition
Fludrocortisone
High Salt Diet |
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Term
| What are the signs, diagnosis, and treatment of 21 hydroxylase deficiency |
|
Definition
Signs:Salt wasting
Hyperkalemia
Virulization in Girls
Only virulization is seen in Late-Onset
Diagnosis: 17 OH Progesterone
Treatment: Corticosteroids +/- Mineralocorticoids |
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Term
| What are some general characteristics of pheochromocytoma |
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Definition
Signs(5 P's) Pallor, Palpitation, Perspiration, Pressure, Pain
Rule of Tens: 10% Bilateral, Malignant, Familial, Children, Recurrance, Extra-renal |
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Term
| Why should you be precautious when you want to biopsy an Adrenal Mass |
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Definition
| It may be a Pheochromocytoma, in which cause the biopsy may kill the patient |
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Term
| How do you diagnose a Pheochromocytoma |
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Definition
24 hr Urine: Catecholamines/Metanephrines
Image with MRI or CT
If inconclusive: MIBG Scan, but give Iodide |
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Term
| What is the treatment for pheochromocytoma? |
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Definition
Alpha then beta block
Surgery after stabilized |
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Term
| How do you work up a patient with a adrenal mass found incidentally on imaging |
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Definition
Screen Pheo and Cushing's
If HPTN, Screen Aldosterone
>4cm->Surgery
<4cm->Observe |
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