1What is the most common cause of Addison's disease?
autoimmune destruction
2What was formerly the most common cause of Addison's disease?
TB
3What are some other causes of Addison's disease?
histoplasmosis
coccidoimycosis
sarcoidosis
HIV
CMV
mestastic tumor
congenital adrenal hypoplasia
4What are the clinical features of Addison's?
weakness
fatigue
anorexia
n/v
weight loss
abdominal pain
mucosal and cutaneous skin pigmentation
hypotension
orthostasis
hypoglycemia
5Why do patients with Addison's disease get a salt craving?
secondary to hyponatremia
6Why do patients with Addison's disease get hypotension?
extracellular fluid depletion secondary to hyponatremia
7What routine labs may appear abnormal with addison's disease?
hyperkalemia
hyponatremia
8What test can be done for screening of Addison's disease?
cortisol response test
9How is the cortisol response test done?
patients baseline serum cortisol/ACTH levels are taken
patient is given 250 ug of cosyntropin IV or IM
serum cortisol levels are drawn 60 minutes later
10What is a positive cortisol response test indicating Addisons disease?
if serum cortisol levels drawn after 60 minutes are less than 18 ug/dL
11If ACTH levels are elevated in the baseline blood sample and they have a positive cortisol response test this suggests?
primary adrenal insufficiency (addison's disease)
12If ACTH levels are normal in the baseline blood sample and they have a positive cortisol response test this suggests?
secondary adrenal insufficiency (non-functioning pituitary adenoma)
13Is acute adrenal crisis more common in primary or secondary insufficiency?
primary
14What is acute adrenal crisis?
insufficient cortisol
15Addisonian crisis is usually precipitated by?
severe stress
prescribed thyroid hormone to patients with untreated adrenal insufficiency
noncompliance or suddent withdrawl of glucocorticoid replacement therapy
b/l adrenalectomy
pituitary necrosis
adrenal injury
IV etomidate (RSI med)
16What is the most common cause of cushing syndrome?
iatrogenic therapeutic glucocorticoid
17What are the nonspecific symptoms of cushing's disease?
central obesity
HTN
osteoporosis
psychological disturbances
acne
hirsuitism
amenorrhea
type II DM
18What are the more specific clinical manifestations of Cushing's syndrome?
bruising
purple striae
proximal myopathy
moon face
bufallo hump
thin/fragile skin
19If patient has cushing's syndrome from an ectopic source what is lab findings are frequently associated?
hypokalemia
metabolic alkalosis
20What are the two requirements for cushing's disease?
increased cortisol production
abnormal cortisol supression in response to dexamethasone
21What are the 3 screening tests?
24 hour urine collection for free cortisol
1 mg overnight dexamethasone challenge
late night saliva cortisol measurement
22What is normal for the 24 hour urine collection?
4-40 ug/24 hours
23What is normal for the 1 mg overnight dexamethasone challenge?
plasma cortisol at 8 AM is less than 1.8 ug/dL
24If you suspect an ectopic source of ACTH or an adrenal tumor what imaging are you ordering?
CT of lungs, thymus, pancreas
25If you suspect a pituitary adenoma or chest CT is clear what imaging are your ordering?
MRI
26What is the treatment for pituitary adenoma?
transphenoidal surgery
radiation
27Uncontrolled levels of cortisol can lead to?
heart disease
type II DM
osteoporosis