Term
| Known as an "adrenal crisis" |
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Definition
- Acute Adrenal insufficiency;
- inadequate ACTH formation or release resulting in decr adrenal hormone (disorder of pituitary gland) |
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Term
| SSx of acute adrenal insufficiency |
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Definition
| hypotension, n/v/d, abd pain, confusion, coma, skin hyperpigmentation |
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Term
| Labs for acute adrenal insufficiency |
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Definition
low ACTH
hypoglycemia
hyponatremia, hyperkalemia
high eosinophil |
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Term
| Tx for acute adrenal insufficiency |
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Definition
hydrocortisone IV
antibiotics |
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Term
| Most common cause of acute adrenal insufficiency |
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Definition
- Abrupt termination of corticosteroid --> body stops making ACTH, no adequate Na+ control or BP control --> coma
- Waterhouse-Friderichsen syndrome (bilateral hemorrhagic infarction) |
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Term
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Definition
- Chronic adrenocorticol insufficiency (primary)
- destruction of adrenal corticies (decr in cortisol, aldosterone, androgens) |
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Term
| Most common cause of Chronic adrenocorticol insufficiency (Addison's Dz) |
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Definition
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Term
| SSx of Chronic Adrenocorticol insufficiency |
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Definition
skin hyperpigmentation
hypotension
weakness
wt loss |
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Term
| Labs for chronic adrenocorticol insufficiency |
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Definition
- high ACTH
- low cortisol (failure to rise after admin of corticotropin)
- CBC - neutropenia, mild anemia, eosinophilia may be present
- EKG
- low serum sodium
- elevated potassium, calcium, BUN |
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Term
| Tx for chronic adrenocorticol insufficiency |
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Definition
- hydrocortisone
- hormone replacement: corticosteroid+minaralocorticoid (due to disruption of renin axis) |
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Term
| Def of Cushing's Dz and Syndrome |
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Definition
hypercortisolism
Cush Dz = Cush syndrome due to pituitary microadenoma |
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Term
| Most common causes of Cushing's |
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Definition
- Pituitary microadenoma (Cushing's Dz)
- *Long-term exogenous corticosteroid ingestion
- adrenal adenoma, adrenocortical carcinoma, excessive secretion of CRH |
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Term
|
Definition
hypertension
Buffalo hump
Moon faces
Straie
Central obesity
Hirsutism
Ecchymosis |
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Term
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Definition
incr serum [cortisol]
dexamethasone suppression test
24hr urine for free cortisol
decr in plasma ACTH |
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Term
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Definition
* Taper the glucocorticoid
- transphenoidal surgery
- Radiation
- Chemotherapy
- Adrenalectomy |
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Term
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Definition
| excessive male pattern hair growth |
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Term
| Causes of Hirsutism and virilization |
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Definition
polycystic ovarian dz (50%)
Congenitcal adrenal hyperplasia
Adrenal hypergonadism
Pregnancy-related hypergonadism
True hermaphroditism |
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Term
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Definition
Excessive male hair growth
galactorrhea
Acne
Infertility
- easy bruising, hpertension, wt gain, acanthosis nigricans |
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Term
| TX for hirsutism and virilization |
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Definition
- *Combination of oral estrogen-progestin therapy
- Oral contraceptive - suppresses ovarian androgen excess
- Vaniqa |
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Term
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Definition
| levels of hirsutism are too high |
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Term
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Definition
Deepening of voice
Breast atrophy
Increased muscle production
Clitoromegaly
Incr libido
Balding |
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Term
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Definition
- Incr serum testosterone and androstenedione
- Incr DHEAS |
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Term
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Definition
Primary hyperaldosteronism
= hypersecretion of the mineralcorticoid aldosterone |
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Term
| Cause of primary hyperaldosteronism |
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Definition
* Unilateral adrenal adenoma (Conn)
- Idiopathic hyperaldosteronism |
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Term
| SSx of primary hyperaldosteronism |
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Definition
Diastolic HTN
severe cases: tetany, paresthesias, peripheral edema |
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Term
| Labs for primary hyperaldosteronism |
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Definition
- Hypokalemia, mild hypernatremia
- Aldosterone suppression test
- Incr ratio of serum aldosterone to plasma renin activity |
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Term
| Tx for primary hyperaldosteronism |
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Definition
* Spironolactone - aldosterone antagonist
- Sodium restriction
- Adrenalectomy |
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Term
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Definition
Catecholamine-producing tumor
- Norepi (20%)
- Epi (80%)
therefore 90% tumors found in adrenal medulla |
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Term
| Causes of Pheochromocytoma |
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Definition
Von Hippel-Lin-dau syndrome
Neurofibromatosis
MEN 2 syndrome |
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Term
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Definition
5 P's
Pressure - sudden incr in BP
Pain - HA, chest and abd pain
Perspiration - sweating
Palpitation - cardiac dysrhythmias
Pallor (or flushing)- blood drains from peripheral circulation |
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Term
| Labs for Pheochromocytoma |
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Definition
- 24hr urine sample for vanillylmandelic acid (VMA)
- Plasma catecholamines (metanephrine and normetanephrine)
- CT scan of adrenal glands - 90% of tumors occur in adrenal |
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Term
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Definition
1. Antihypertensive Tx alpha-blocker
2. Beta-blocker to control tachycardia
3. Surgical resection |
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Term
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Definition
= any condition producing diffusely decr bone density (osteopenia) and diminished bone strength
Osteoporosis
Paget's Dz of bone
Osteomalacia |
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Term
| Most common metabolic bone disorder |
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Definition
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Term
| Bone Dz characterized by low bone mass/density |
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Definition
Osteoporosis
- bone formation < bone reabsorption
- loss of trabecular bone > loss of compact bone |
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Term
| Who are more susceptible to osteoporosis |
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Definition
| postmenopausal women, esp Caucasian and Asian |
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Term
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Definition
Hormone deficiency or excess
immobilization
alcohol
smoking
genetics |
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Term
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Definition
* often asymptomatic
backache
spontaneous Fx -->femoral neck Fx, distal radius Fx
Collapse vertebrae
loss of height |
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Term
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Definition
* DEXA scan (for any bone, usually hip or spine)
- CT densiometry - vertebrae
- nml Alk Phos (usually),may be elevated
- nml serum calcium, phosphate, PTH |
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Term
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Definition
Hormone replacement therapy
bisphosphonates
SERMS - selective estrogen receptor modulators
Prevention: *exercise, Vit D, calcium, calcitonin nasal spray, diet, no smoking |
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Term
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Definition
| Defective skeletal mineralization due to Vit D deficiency; can't lay down bone properly (bone osteoid) |
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Term
| What is osteomalacia in children? |
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Definition
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Term
| What are the causes of osteomalacia |
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Definition
Vit D deficiency
deficient intake of Ca/Phos
genetic: hypophosphatasia
Fibrogenesis - "fishnet" appearance |
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Term
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Definition
usually starts asymptomatic
bone pain and tenderness
painful proximal muscle weakness
Fx with no associated trauma |
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Term
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Definition
elevated Alk Phos
nml or low Calcium and phosphorus
X-ray: thinning of corticol bone, stress, Fx, looser lines and bone softening |
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Term
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Definition
ergocalciferol for deficiency (long-acting Vit D
-prevention: vit D, sun exposure |
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Term
| characterized by high bone turnover rate and disorganized osteoid formation |
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Definition
Paget's dz of bone (have enlarged and deformed bone)
- will get areas with "big holes" and other areas that are more dense |
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Term
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Definition
3/4 asymptomatic; may involve 1 bone (monostotic) or multiple bone (polyostotic) - skull, femur, tibia, pelvis
- bone pain* - 1st symptom
- Bones become soft- kyphosis (curvature of spine), bowed tibia,
- if skull involved: HA, incr had size, deafness, cranial nerve palsies |
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Term
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Definition
Very high Alk Phos
nml or incr serum Calcium
nml serum phosphorus
Elevated urinary hydroxyroline |
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Term
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Definition
no cure
slow bone resorption: bisphosphonates |
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