Family Medicine EOR: Endocrinology (Smarty PANCE) Exam Questions and Answers 100% Verified and Updated 2024 | Graded A

Family Medicine EOR: Endocrinology (Smarty PANCE) Exam Questions and Answers 100% Verified and Updated 2024 | Graded A What are the clinical features of adrenal insufficiency? Nausea, vomiting, weakness, fatigue, lethargy, weight loss, anorexia, and hyperpigmentation 3 types of adrenal insufficiency? 1. Primary (problem w/ adrenal gland itself) 2. Secondary (steroid withdrawal or pituitary issue) 3. Tertiary (hypothalamus) What is acute and chronic adrenocortical insufficiency? ● Acute adrenocortical insufficiency (adrenal crisis) is an emergency caused by insufficient cortisol ● Chronic adrenocortical insufficiency or primary adrenal insufficiency (Addison disease) is caused by dysfunction or absence of the adrenal cortices What is secondary adrenal insufficiency? Secondary adrenal insufficiency is adrenal hypofunction due to a deficient secretion of ACTH by the pituitary gland which may be isolated or occur in conjunction with other pituitary hormone deficiencies. ACTH and cortisol levels both are low. What are causes of secondary adrenal insufficiency? ● Iatrogenic (adrenal suppression from prolonged steroid use) ● Pituitary or hypothalamic adenoma ● Long-term glucocorticoid therapy ● Sheehan syndrome (severe low blood pressure during or after childbirth) ● Traumatic brain injury ● Subarachnoid hemorrhage What is the cause of tertiary adrenal insufficiency? Tertiary adrenal insufficiency refers to impaired hypothalamic release of corticotropin-releasing hormone (CRH) with resulting decreased production of ACTH by the pituitary. The most common causes of tertiary adrenal insufficiency, also suppress corticotropin (ACTH) secretion: ● Abrupt cessation of high-dose glucocorticoid therapy ● Correction (cure) of hypercortisolism (Cushing's syndrome) What are the etiologies of primary adrenal insufficiency? Most commonly from autoimmune destruction of the adrenal cortex. Plasma ACTH is high and serum cortisol levels are low. ● Autoimmune destruction (most common as Addison disease) ● Tuberculosis (leading cause where TB is prevalent) ● Adrenal hemorrhage (i.e., sepsis, anticoagulation therapy, antiphospholipid antibody syndrome) ● Congenital Primary? Secondary? Tertiary? Primary = adrenal (ACTH high and cortisol low) Secondary = pituitary (ACTH low and cortisol low) Tertiary = hypothalamic (ACTH and cortisol low with exaggerated and prolonged ACTH response with administration of CRH - corticotropin releasing hormone test) Evaluation of patients with possible adrenal insufficiency? For most patients measuring 8 AM serum cortisol and plasma ACTH, and a high- dose 250 mcg ACTH stimulation test Test to differentiate between secondary and tertiary adrenal insufficiency? CRH Stimulation Test: the differentiation between secondary and tertiary adrenal insufficiency can be made by the administration of corticotropin-releasing hormone (CRH) ● Secondary (pituitary) - low ACTH and low cortisol - there is little or no ACTH response in patients with secondary (pituitary-related) adrenal insufficiency ● Tertiary (hypothalamic) - low ACTH and low cortisol - patients with tertiary disease due to lack of CRH from the hypothalamus usually have an exaggerated and prolonged ACTH response What are common laboratory findings associated with adrenocortical insufficiency? ● WBC count with moderate neutropenia, lymphocytosis, and total eosinophil count over 300/μL ● Low serum Na+ (due to low aldosterone) ● Elevated K+ (due to low aldosterone) ● Low fasting blood glucose (due to lack of cortisol) ↑ ACTH (from pituitary hypersecretion) + ↓ Cortisol (failure of the adrenal cortex) + ↓ Aldosterone Primary adrenocortical insufficiency (Addison's disease) ↓ Cortisol, ↓ ACTH, and normal aldosterone Secondary or tertiary ↓ Cortisol, ↓ ACTH, normal aldosterone, with little or no ACTH response during corticotropin-releasing hormone test Secondary adrenocortical insufficiency ↓ Cortisol, ↓ ACTH, normal aldosterone, with exaggerated and prolonged ACTH response (↑ ACTH) with the administration of CRH corticotropin-releasing hormone test Tertiary adrenocortical insufficiency (HPA suppression) What are causes of adrenal crisis?