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Endocrine Exam 2
Terms in this set (86)
The release of which hormone from the pituitary stimulates the release of glucocorticoids from the Adrenal Glands?
Which of the following is the primary glucocorticoid in our body?
A. cortisol :)
When are cortisol levels at their highest? lowest?
lowest: around midnight
WTF does cortisol even do? (2 things im looking for here)
-assists epinephrine in creating short-term memories triggered by emotions
What is the principal mineralocorticoid?
(aldosterone causes sodium retention and potassium excretion aka it increases your BP)
T/F: Androgens produced by the adrenal cortex have no significant effect in adult males.
the adrenal glands barely produce any androgens. they all come from the testes.
What 2 hormones are produced in the adrenal medulla?
norepinephrine and epinephrine
Does calcium have anything to do with the release of norepi and epi?
NE and Epi are released via exocytosis which requires calcium!
Which of the following is NOT a function of epinephrine?
A. increases heart rate
B. increases respiratory rate
C. trigger lipolysis
D. smooth muscle contraction in airways
D!!! it causes smooth muscle relaxation in airways (aka bronchodilation)
What's the difference between Sloan Kettering and Shea stadium?
The mets always win at Sloan Kettering.
T/F: Norepinephrine can stabilize the mood and be used to treat anxiety and depression.
True!!! (remember his story about Sully)
Which pathology of the adrenal glands is an emergency?
A. adrenal crisis
C. Cushing Syndrome
A. adrenal crisis!
(Caused by insufficient cortisol)
Which of the following is NOT a possible cause of acute adrenal insufficiency?
A. prednisone withdrawal
B. adrenal injury
C. physiological stress
E. Stage IV Syphilis
hehehe the syphilis one :)
(Etomidate is that drug used to intubate patients)
Patient is a 58 year old male presenting to the ER due to a syncopal episode. He is a Type I diabetic and is verryyyy hypoglycemic right now. He also says he has a headache, diarrhea, and has been feeling abnormally indifferent about everything all day. On PE you note a very low blood sugar, a fever of 105, and a BP of 96/64. You are informed he was recently on prednisone for months for a very bad asthma exacerbation. What do you suspect is wrong with this patient?
Acute adrenal insufficiency!
my big clues were:
-type I diabetic w/ hypoglycemic event
-LOW BP! (bc roids increase your BP and he ain't got no roids)
-fever thru the roof
-lassitude ("i dont care")
-recent prednisone (withdrawal from this prolly caused his adrenal insufficiency)
What will happen if you give prednisone to a diabetic?
A. it will kill them
B. they will get cancer
C. it will elevate their glucose
D. they will develop ED
C. it will elevate their blood glucose as the day progresses. (bc its a glucocorticoid and it opposes insulin so the glucose just chills in the blood and doesnt go anywhere)
(the answer is only D if your name is Tony)
T/F: Acute adrenal insufficiency can cause hypopigmentation of the skin.
What is the name of the syndrome that causes meningococcemia, purpura, and adrenal insufficiency? (and what causes it?!?!?!)
Select the correct pairing of common lab findings in a patient with Acute Adrenal Insufficiency.
A. hyponatremia, hypokalemia
B. hypernatremia, hypokalemia
C. hypernatremia, hyperkalemia
D. hyponatremia, hyperkalemia
D! HYPOnatremia, HYPERkalemia (tip: remember sodium and potassium are always opposites. you see these lab results bc if the adrenal glands aren't working they aren't producing aldosterone....and aldosterone causes Na retention and K excretion)
What test should be done to diagnose acute adrenal insufficiency?
Cosyntropin Stimulation Test
-Cosyntropin= synthetic ACTH
-measure cortisol levels at like 8am, give cosyntropin, check levels again in 30-60 min, serum cortisol levels should double!!!!!
(pt with adrenal insufficiency will not respond to this test bc their adrenals won't respond to the stimulation from ACTH like they're supposed to bc they're broken!)
When does CPR become necrophilia?
When you're both stiff.
You suspect a patient might have adrenal insufficiency. You want to do a cosyntropin stimulation test. This patient tells you he is taking prednisone because he had an asthma attack yesterday. What must you consider in this patient?
prednisone doesnt mess with this test!
must be stopped 8 hrs prior!
(fun fact: this is bc hydrocortisone legit IS cortisol so obv it'll screw up your test)
You do a cosyntropin stimulation test on a normal patient. What do you expect their serum cortisol levels to rise to?
> 18-20 ug/dL!!
in adrenal insufficiency pts cortisol levels are usually lower than 10 to begin with....so if their levels double after this test it will be less than 20....keep that in mind
How do you treat a patient in the acute phase of adrenal crisis?
IV hydrocortisone mixed in with Normal Saline (0.9% NaCl)!!!!!
Then: hydrocortisone sodium succinate or hydrocortisone phosphate
-treat their hypoglycemia!
What's the difference between the acute and convalescent phase....lmao
convalescent phase is once the patient is stable :)
How do you treat a patient who is now stable (convalescent phase) of adrenal crisis?
fludrocortisone- helps treat hyponatremia!
What is the name of the disease characterized by a chronic deficiency of cortisol?
Patients with Addison Disease will have (high / normal / low) ACTH levels. (pick one)
HIGH ACTH! bc the pituitary is trying to stimulate the adrenal glands
What is the most common cause of chronic adrenal insufficiency in the US? What about in underdeveloped countries?
underdeveloped countries: TB!
Which of the following is not a cause of Addison Disease?
A. adrenocortical hormone withdrawal
B. autoimmune destruction
D. bilateral adrenal hemorrhage
F. congenital adrenal hyperplasia
A! hormone withdrawal causes acute adrenal insufficiency :)
How do you diagnose hypospadias on an EKG?
look for an abnormal P wave.
WTF is adrenoleukodystrophy?
-X linked disorder
-causes accumulation of long chain fatty acids in the adrenal cortex
What are some signs/symptoms associated with Addison Disease?
Patient comes into your office and looks like he he just came back from a very long tropical vacation. It's the middle of January. You ask and he tells you he hasn't been on vacation since Nam. What disease do you suspect?
they get the hyperpigmentation of the skin without sun exposure!
What lab findings are suggestive of Addison Disease?
-hyponatremia and hyperkalemia (w/ chronic Addisons disease)
-serum DHEA levels under 1000 ng/ mL in 100% of patients with Addison disease!!!!!!!!!!
What serum test should you do in a young man presenting with suspected Addison Disease?
serum very long-chain fatty acid levels!!!!
What 2 lab findings are diagnostic for Addison Disease?
LOW cortisol and ELEVATED ACTH!!!!!
What imaging would you do if you suspected Addison Disease?
What will you see on abdominal CT if a patient has Addison Disease?
Autoimmune Addison: small, noncalcified adrenals
Metastatic disease: Enlarged adrenals
TB, Pheochromocytoma, Melanoma: Calcified adrenals
T/F: Patients with Addison disease should wear a medical ID tag.
it should say "Adrenal Insufficiency- takes Hydrocortisone" bc if they go down and miss their drugs...can go into adrenal crisis and that is NOT good my friends. NOT GOOD.
How do we treat Addison Disease?
Why do women love going to see old gynecologists?
Their hands shake.
T/F: DHEA will improve fatigue, cognitive problems, and sexual dysfunction associated with Addison Disease.
it doesn't really improve these things, but the placebo effect might.... evil laugh
What is the difference between Cushing Syndrome and Cushing Disease?
SYNDROME is the manifestations of excessive corticosteroids.
DISEASE is excessive pituitary release of ACTH
(remember: DISEASE=PITUITARY ORIGIN!)
What commonly causes Cushing Syndrome?
A. a hard punch to the CVA
D. Cushing Disease
What are some common signs/symptoms of Cushing Disease?
-fat torso, skinny arms/legs
(picture Betty...our cadaver)
T/F: A Patient with Cushing Disease will likely have hypotension.
these mofos have TOO MUCH steroid secretion so they will be HYPERtensive :)
T/F: Patients with Cushing Disease will have thirst/polyuria due to their decreased blood glucose levels.
sooo close to being true! but its false af.
they will have thirst/polyuria, but this is because cortisol INCREASES blood sugar!!
What test can be done if you suspect Cushing Disease?
Dexamethasone Suppression Test!
-give dexamethasone at 11pm, measure serum cortisol at 8am.
-NORMAL PT: dexamethasone will trick the pituitary to not release ACTH so no cortisol will be released and cortisol levels will be NORMAL at 8am! (when they usually are high)
-CUSHINGS PT: pituitary says screw you and cortisol levels will still be high at 8am
What are the NORMAL values for both the Fluorometric assay and the HPLC assay when performing the Dexamethasone Suppression Test?
Fluorometric Assay: cortisol <5 mcg/dL
HPLC Assay: cortisol <1.8 mcg/dL
What's the hardest part of being a pharmacist?
Failing out of medical school.
(I'm sorry that was so bad lmao)
What other test can you do if your dexamethasone suppression test was not helpful and you still kinda suspect hypercortisolism?
24hr urine for free cortisol and creatinine.
> 95 mcg cortisol/g of creatinine
Which of the following will not cause a false indication of Cushing's during Dexamethasone suppression test?
A. anti-seizure meds
D. recent mental breakdown
D...even tho most of us are on the verge of a mental breakdown currently
You want to do a midnight serum cortisol level on a patient who has been in Europe for 2 weeks and just came back yesterday. Will this test be reliable?
um no. they have the be in the same time zone for 3 days.
(fun fact: serum cortisol should be low at midnight)
Where do you sample ACTH from if you suspect a pituitary cause of Cushing Disease?
Inferior Petrosal Sinus (the veins that drain the pituitary)- these levels will be more than 2x the ACTH levels in a peripheral vein
What tests do you do to find the CAUSE of hypercortisolism?
1. Serum ACTH (low=adrenal issue, high= pituitary or ectopic)
2. CT Scan (to r/o adrenal cancer)
3. MRI (r/o pituitary lesion)
4. ACTH from inf petrosal sinus (r/o pituitary)
5. Octreotide Scan (to find ectopic ACTH producing tumors)
T/F: Cushing Disease can cause the same hyperpigmentation seen with Addison Disease.
you can get hyperpigmentation w Cushing's, but it's
, not the bad spray tan bronzing look
Which of the following is not an appropriate treatment option for a patient with Cushing Disease?
A. transsphenoidal selective resection
B. long term hydrocortisone
C. cabergoline (Dostinex)
D. gamma knife surgery
E. expectant management
How do we treat hypercortisolism caused by adrenal neoplasm?
-take the shit out
-mitotane (Lysodren) to prevent mets
How do you treat an ectopic ACTH-secreting tumor?
-take the shit out
-octreotide LAR (can suppress ACTH secretion)
Why do single men hate aspirin?
Because it's a COX blocker.
T/F: Primary aldosteronism will cause hyperkalemia.
HYPOkalemia! aldosterone makes you pee out all your potassium.
T/F: All hypertensive patients with chronic low potassium should be tested for primary aldosteronism.
What stimulates aldosterone production?
Which of the following meds will NOT affect the aldosterone:renin ratio?
drugs that do NOT affect aldosterone:renin ratio:
-a-blockers (end in -sin)
What tests are done to diagnose primary aldosteronism?
-serum aldosterone:PRA ratio
-24hr urine for aldosterone
low PRA, high urine aldosterone = PRIMARY ALDOSTERONISM!
When should you screen for hyperaldosteronism? (6 situations)
3. htn w/
4. htn w/
5. FH of
early onset HTN
6. htn w fam w primary aldosteronism
How do you treat hyperaldosteronism caused by Conn syndrome?
how do you treat hyperaldosteronism caused by bilateral adrenal hyperplasia?
Spironolactone (has anti-androgen effects in men....we no likey dat)
(no man titties=happy patient)
What is Pheochromocytoma?
tumor of the adrenal medulla that oversecretes NE/Epi
Why does a neurosurgeon think he's God?
Because he turns humans into vegetables.
What do patients with MEN2A have a 100% chance of getting?
B. pituitary adenoma
C. parathyroid hyperplasia
D. medullary thyroid carcinoma
D! medullary thyroid carcinoma******
T/F: MEN 1 is associated with pheochromocytomas.
MEN 2A and 2B!!!!!
Why is pheochromocytoma fatal?
it can cause hypertensive crisis and fatal cardiac arrhythmias for no apparent reason at all
What lab test is the single most sensitive test for pheochromocytoma?
Plasma fractionated free metanephrines!!
(normal levels r/o pheo, elevated levels need further workup)
What test do you do next if the plasma fractionated free metanephrine level is elevated?
Urinary fractionated metanephrine assay
of total metanephrine, OR
What imaging modality is preferred to check for pheochromocytoma?
non-contrast CT of adrenals!
(remember contrast can cause a paroxysm and kill the person)
-or an MRI. both work fine tbh
what is the name of a epi/NE secreting tumor NOT found in the adrenal glands?
What is the name of the nuclear med scan used to detect pheochromocytomas that were not located on CT scan?
(also done 3mths post-op to check for recurrence or mets)
What nuclear imaging test is very sensitive for paraganliomas and metastatic pheochromocytomas?
What do you call an epileptic in a garden?
How do we medically treat patients with pheochromocytomas (aka before they have surgery)
some combo of a-blocker, BB, CCBs to control HTN and tachyarrhytmias before surgery
What is the treatment of choice for pheochromocytoma?
What is the DOC for controlling sever HTN during surgery in a patient with pheochromocytoma?
Where in the testes is androgen (aka testosterone) produced?
T/F: Sertoli cells are stimulated by LH to produce spermatocytes.
they are stimulated by FSH!
(FSH=reproductive function, LH= endocrine function)
T/F: Hypogonadism refers to a condition where a male has only one testicle.
hypogonadism= decreased production of testosterone
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