1DDX: LECTURE 47 – APRIL 13TH, 2007 Endocrine (3), Adrenal Cortex (No page numbers: we didn’t get this note package

until the next class) THYROID: Women outstrip men in benign conditions of the thyroid, but men outstrip women in malignant conditions. Specific conditions of the thyroid that affect elderly (>50): Toxic multinodular goiter. 20-30 years old, tends to be more autoimmune conditions. Graves is associated with pernicious anemia, rheumatoid arthritis. Find a cold nodule? Red flag for cancer. ADRENAL: Patient may present with diffuse pigmentation on flexor surfaces, around scars, areola, mucus membranes. DDX: systemic sclerosis due to thickening of the skin. Buccal fat pad enlargement: cushings Cushings: thinning of skin, bruises easily. Lab tests? Serum ACTH and Serum cortisol are most useful. Serum ACTH: Decreased: steroids suppress adrenals. Estrogen, alcohol, insulin: may elevate ACTH. Serum cortisol: Lowest at 12pm. First sign of loss of diurnal variation: assess via salivary cortisol. Urinary 17-OCHS: useful for alcoholic cirrhosis. Liquorice increases 17-OCHS In severe stress, adrenals produce less androgens and more cortisol. Aldosterone: level greatly increases in upright position. Congenital adrenal hyperplasia: 1. Simple virilizing CAH 2. Salt-wasting: losing all your salt. Addison’s Hyperpigmentation (primary) ex. JFK Electrolyte tests are off in primary. In secondary Addison’s they are normal.


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