128: Adrenal

Question 1

excess production of catecholamines due to adrenal tumour

Answer 1

phaeochromocytoma

Question 2

excess production of cortisol by zone fasiculata. caused by adrenal tumour/pituitary tumour/or ectopic ACTH production

Answer 2

Cushings syndrome

Question 3

pituitart tumour secreting ACTH causing cushings syndrome

Answer 3

cushings disease

Question 4

endocrine hypertension caused by excess secretion of aldosterone from zone glomerulosa

Answer 4

conn’s syndrome

Question 5

primary adrenal insufficiency caused by auto immune disease or TB

Answer 5

addison’s

Question 6

21 hydroxylase deficiency ( aldosterone precursor). causes reduced aldosterone secretion in children and excess androgen production in adults

Answer 6

Congential Adrenal Hyperpalsia.

Question 7

phaeochromocytoma symptoms

Answer 7

intermittent or sustained hypertension, sweating, tachycardia, headaches

Question 8

symptoms of cushings

Answer 8

central obesity, buffalo hump, red round face, high blood pressure, poor wound healing, thin skin, hirsutism, depression, fatigue.

Question 9

symptoms of conns

Answer 9

hypertension, hypokalaemia, metabolic acidosis

Question 10

symptoms of addisons

Answer 10

pigmentation, general malaise, nausea, vomiting, hypoglycaemia, postural hypotension, weight loss.

Question 11

symptoms of congenital hyperplasia

Answer 11

salt wasting in children, pseudo-hermaphroditism at birth, short stature, hirutism, impaied fertility. PCOS is common presentation in female.s

Question 12

what is pseudo-hermaphroditism?

Answer 12

individuals of one sex have external genitalia of the other sex.

Question 13

investigation for phaeochromocytoma?

Answer 13

24h urinary catecholamines will be elevated. you could then scan for tumour MRI/CT

Question 14

invesigations for cushings syndrome/disease

Answer 14

Low ACTH suggests adrenal disease.
High ACTH suggests pituitary disease.
low dose dexamethasone at midnight should suppress cortisol at 9am. Cushings if not suppressed. also check 24h urine for cortisol - elevated.

Question 15

investigations for Conn’s

Answer 15

morning blood sample should have low rennin and high aldosterone. confirm with adrenal CT/MRI

Question 16

investigations for Addison’s

Answer 16

hyperkalaemic, hyponatraemic, hypoglycaemic, inadequate cortisol response to synacthen (should stimulate cortisol). elevated basal ACTH.

Question 17

what does synacthen do? what disease is it used to identify?

Answer 17

stimulates cortisol production at the adrenals. test for Addison’s (primary adrenal insufficiency)

Question 18

investigation for congenital adrenal hyperplasia

Answer 18

elevated 17alpha hydroxyprogesterone before and after synacthen stimulation.

Question 19

treatment of congenital adrenal hyperplasia

Answer 19

dexamethasone, oestrogen, and cyproterone for adults.

fludrocortisone and hydrocortisone for salt wasters ( i.e. children)

Question 20

treatment for addisons

Answer 20

hydrocortisone and fludrocortisone

Question 21

treatments for conn’s

Answer 21

adrenalectomy for an adenoma. low sodium diet and spirolactone if bilateral adrenal hyperplasia.

Question 22

treatment for cushing’s

Answer 22

Metyrapone ( cortisol synthesis inhibitor) surgery to remove tumour.

Question 23

treatment for Phaeochromocytoma

Answer 23

alpha and beta blockers (phenoxybenzamine and propranol).
high salt diet ( to compensate low BP and hypovolaemia)
then surgery