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MEH > 19. Adrenal Disorders > Flashcards

19. Adrenal Disorders Flashcards

1
Q

What are the 3 layers of the adrenal cortex from outside in and what do they secrete?

A

Zona glomerulosa - mineralocorticoids
Zona fasiciculata - glucocorticoids
Zona reticularis - androgens

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2
Q

What is the clinical presentation of cortisol deficiency?

A

Weakness
Tiredness
Weight loss
Hypoglycaemia

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3
Q

What is the clinical presentation of a mineralocorticoid (aldosterone) deficiency?

A

Dizziness
Low Na
High K

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4
Q

What is the clinical presentation of an androgen deficiency?

A

Low libido

Loss of body hair in women

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5
Q

What is the clinical presentation of a cortisol excess?

A

Weight gain and cushingoid features

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6
Q

What is the clinical presentation of mineralocorticoid excess?

A

High BP and low K

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7
Q

What is the clinical presentation of androgen excess?

A

Increased male characteristics in women

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8
Q

What is the clinical presentation of ACTH excess from pituitary?

A

Skin pigmentation melanocyte stimulation

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9
Q

What is the presentation of excessive catecholamine secretion?

A 
Acute episodes
Sweating
Anxiety
Palpitations
High or low BP
Collapse
Sudden death
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10
Q

What will the biochemical assessment show if suspected adrenal hormone deficiency?

A

Electrolytes - low Na, (high K in aldosterone deficiency)
0900 basal cortisol - low
Stimulation test

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11
Q

What will the biochemical assessment show if suspected adrenal hormone excess?

A 
Electrolytes - high BP, low K
Midnight cortisol - high
24hr urine cortisol - high
Suppression test - failure to suppress 
Androgens and derivatives - high
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12
Q

What foods should be avoided before a biochemical assessment of adrenal medulla?

A 
Coffee
Coke
Bananas
Chocolate
Vanilla
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13
Q

What are the catecholamines in the 24 hr urine?

A

Adrenaline
Noradrenaline
Dopamine
3-methoxy-tyramine

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14
Q

What is primary adrenal failure (Addison’s disease) mainly due to?

A

Auto-immune disease

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15
Q

What are the symptoms of Addison’s disease?

A 
Fatigue
Weakness
Anorexia
Weight loss
Nausea
Abdominal pain
Dizziness 
Pigmentation
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16
Q

What are the signs of Addison’s disease?

A 
Underweight
Signs of weight loss
General malaise
Other auto-immune diseases - vitiligo, thyroid
Postural hypotension
Pigmentation
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17
Q

What are the causes of primary adrenal failure?

A 
Auto-immune 
Infection - TB, fungal, AIDS
Infiltration - amyloid, haemochromatosis
Malignancy - lung, breast, kidney
Genetic - CAH, adreno-leukodystrophy
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18
Q

What are the clinical features of adrenal crisis?

A 
Collapse
Hypotension
Dehydration
Pigmentation
Coma
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19
Q

What do the blood tests in adrenal crisis show?

A 
Low sodium
High potassium 
High urea
High creatinine 
Low cortisol levels
20
Q

What is the initial treatment of adrenal crisis?

A

Rapid rehydration with fluids
IV hydrocortisone
Correction of hypoglycaemia
Search for precipitating cause

21
Q

What is the maintenance treatment of Addison’s disease?

A

Lifelong replacement

  • glucocorticoid (hydrocortisone, prednisolone)
  • mineralocorticoid (fludrocortisone)
22
Q

What is the difference in results between ACTH deficiency and primary adrenal failure?

A

in ACTH deficiency:
No pigmentation as ACTH not raised
No hyperkalaemia as no mineralocorticoid deficiency
Hyponatraemia due to effect of cortisol on free water excretion

23
Q

What is Cushing’s syndrome?

A

Glucocorticoid excess

24
Q

What are the signs and symptoms of Cushing’s syndrome?

A 
Round pink face with round abdomen
Skinny and weak arms and legs
Thin skin and easy bruising
Red stretch marks on abdomen
High BP and diabetes
Osteoporosis
25
Q

What are the causes of Cushing’s syndrome?

A

Pituitary tumour
Adrenal tumour
Ectopic ACTH
Patients taking steroids

26
Q

Why do the arms and legs become thinner in Cushing’s syndrome?

A

Excess cortisol causes lipolysis and break down of protein in muscle

27
Q

What is adrenal Cushing’s syndrome?

A

Adrenal tumour secreting glucocorticoids

May also secrete cortisol metabolites

28
Q

What is the presentation of adrenal Cushing’s syndrome?

A

ACTH is suppressed
Androgenic symptoms may be present - hirsutism, acne, greasy skin
Virilising features in large tumours - androgenic alopecia, deep voices, clitoromegaly

29
Q

What is the treatment for adrenal Cushing’s syndrome?

A

Adrenalectomy

30
Q

What is the risk after an adrenalectomy?

A

Post-op hypoadrenalism risk due to contra-lateral adrenal suppression

31
Q

What is primary hyperaldosteronism?

A

Excess production of aldosterone from adrenal gland

32
Q

What is Conn’s syndrome?

A

Aldosterone-secreting adrenal adenoma

33
Q

What is the commonest form of endocrine hypertension?

A

Primary hyperaldosteronism

34
Q

What does primary hyperaldosteronism cause?

A

Hypertension and hypokalaemia
High aldosterone and suppressed renin
Scan shows adrenal adenoma or bilateral hyperplasia

35
Q

How is Conn’s adenoma treated?

A

Surgery

36
Q

How is bilateral hyperplasia treated?

A

Aldosterone antagonists - spironolactone/eplerinone

37
Q

What is congenital adrenal hyperplasia?

A

Autosomal recessive
Adrenal crisis and ambiguous genitalia
Caused by a block in adrenal cortex pathway
Presentation depends on enzyme defect

38
Q

What does the lack of enzyme in congenital adrenal hyperplasia lead to?

A

Low cortisol and aldosterone

High male hormone (androgens)

39
Q

Which enzyme is most commonly absent in congenital adrenal hyperplasia?

A

21-hydroxylase

40
Q

What is the presentation of congenital adrenal hyperplasia?

A 
Hypotension
Hyponatraemia
Hyperkalaemia
Hypoglycaemia
Virilisation
41
Q

What is the treatment of congenital adrenal hyperplasia?

A

Treat adrenal crisis
Determine sex of baby
Long term GC and MC
Corrective surgery

42
Q

What is phaeochromocytoma?

A

Tumour of adrenal medulla

43
Q

What is paraganglioma?

A

Extra-adrenal tumour- chromaffin tissue origin

44
Q

What are the symptoms of phaeochromocytoma and paraganglioma?

A 
Acute episodes
Sweating
Panic attacks
Palpitations
High or low BP
Collapse
45
Q

What happens in acute crisis of phaeochromocytoma and paraganglioma?

A 
Hypertensive crisis
Encephalopathy
Hyperglycaemia
Cardiac arrhythmias
Sudden death
46
Q

What are the investigations needed for phaeochromocytoma and paraganglioma?

A

24hr urine metanehrines
2-3 collections needed
Plasma metanephrines

47
Q

What is the management for phaeochromocytoma and paraganglioma?

A

Alpha blockade - phenocybenzamine
Beta-blockade - bisoprolol
Surgical excision

MEH (22 decks)

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