Endocrinology Week 5 Summary

Question 21

How is the presentation different between patients with primary versus secondary cortisol deficiency?

(Both have hyponatremia)

Question 22

How do you counsel patients with Addison’s disease? List 5 items.

• It is very important to take your medications (cortef, florinef) every day
• If you get sick:
  • Double or triple your dose of cortef until you are well
  • See a doctor if you still need a higher dose after 3-5 days
• If you cannot keep medications down despite Gravol, go to emergency room for intravenous steroids
• Get a Medic Alert bracelet
  • High dose of steroids will be needed for bad accidents or surgery
• Fill a prescription for injectable dexamethasone and needles if going to remote areas

Question 23

List 4 genetic syndromes which are associated with pheochromocytoma. What are the other manifestations of these syndromes?

Question 24

Sarah Hughes is a 45-year old woman with new onset hypertension 180/110. Her blood pressure remains elevated despite the use of three antihypertensive agents.

List 5 lifestyle questions you would ask her.

• Salt intake
• Alcohol intake
• Caffeine
• Smoking adherence to medications
• Licorice ingestion
• Use of NSAIDS
• Cocaine
• Amphetamines
• Cold medications
• Oral contraception

Her potassium is low at 2.8 mmol/L, and you suspect hyperaldosteronism. How do you screen for hyperaldosteronism? How would you confirm the diagnosis of primary hyperaldosteronism?

Screen:

• Elevated serum aldosterone (>400 nmol/L);
• Elevated ratio of aldosterone:renin >140 (100-140 “grey zone”) (using renin measured as mass not activity, beware of units!)

Confirm with saline suppression test: 2 L saline infused IV over 4 hours, plasma aldosterone afterwards elevated >280 nmol/L

CT image (hyperplasia vs adenoma)

Adrenal vein sampling if image is confusing, or patient is >45 years old

Question 25

How do you investigate the patient with an adrenal incidentaloma?