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NURS 642 (Endocrine) EXAM 3 STUDY GUIDE LATEST AND ACCURATE SOLUTIONS.
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NURS 642 (Endocrine) EXAM 3 STUDY GUIDE LATEST AND ACCURATE SOLUTIONS.
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NURS 642 (Endocrine) EXAM 3 STUDYGUIDE LATEST AND ACCURATE SOLUTIONS.
What is cushing syndrome?
Correct Answer --hypercortisolism
Causes of Cushing's Syndrome?
Correct Answer --Overproduction of cortisol by adrenals
-Medications such as prednisone taken to control asthma, arthritis and
other inflammatory diseases or immunosuppression after transplant
- ACTH secreting tumors (lungs, pancreas, thymus, adrenal, GI tract, thyroid)
Signs and symptoms of cushing syndrome?
Correct Answer --increased body fat/ "moon face", abd striae
-depression/mood swings
-fragile skin; easily can have ecchymosis
-low immune response which increases risk of infections
-stomach ulcers, GI bleeding
-high BS, may need insulin injections
-loss of Ca++ from bone, which leads to osteoporsis
-polyuria
-hypokalemia may be present
Workup for cushing's syndrome?
Correct Answer --Dexamethasone suppression test
,What other autoimmune disorders can occur with Addison's disease?
Correct Answer --Autoimmune thyroid disease (Hashimoto or Graves)
-Celiac disease
-DM 1
-Hypoparathyroidism
-Primary ovarian insufficiency
-Pernicious anemia
-Primary gonadal failure
What is an adrenal incidentaloma?
Correct Answer -it is the finding of an adrenal mass on imaging that is
greater than 1cm in diameter with the prevalence being higher in people
who are obese, diabetic and hypertensive
Bilateral adrenal masses can be seen with what?
Correct Answer -with metastatic disease, congenital hyperplasia, cortical
adenomas, lymphoma, infection, hemorrhage, ACTH cushing's,
pheochromocytoma, primary aldosteronism, amyloidosis, infiltrative
disease of adrenals, bilateral macro-nodular adrenal hyperplasia
Evaluation of adrenal incidentaloma?
Correct Answer -1. eval for malignancy (uncommon w/o known cancer)
- risk factors
- mass size > 4cm
- male sex, older age, larger tumor size, higher unenhanced CT attenuation
, 2. eval for hormonal secretion
A) Subclinical cushing
- clinical s/s of cushing's (HTN, dyslipidemia, DM, weight gain, osteoporosis,
evidence of atherosclerosis, Afib
- obtain serum DHEAS
- overnight dexamethasone suppression test (don't do this if thought to have
pheochromocytoma/unenhanced attenuation CT > 10)
- also check serum aldosterone and renin
What is an abnormal overnight dexamethasone suppression test?
Correct Answer -a cortisol > 1.8mcg/dl
*and if so then must be further evaluated with a 24 hour urine free cortisol,
check urine ACTH, and high dose 8mg overnight DST and is confirmed if it is
>1.8
What are typical findings on imaging of benign adrenal masses?
Correct Answer -- Round, homogenous density, smooth contour, sharp
margin
- Diameter < 4cm and unilateral
- Low unenhanced CT attenuation 10 or less
- Rapid contrast washout w/in 10 min of administration
- Isointensity with liver on T1 & T2 weighted MRI
- Chemical shift evidence of lipid on MRI
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