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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
What are the causes of Cushing’s syndrome?
Pituitary tumour Adrenal tumour Ectopic ACTH Patients taking steroids
26
Why do the arms and legs become thinner in Cushing’s syndrome?
Excess cortisol causes lipolysis and break down of protein in muscle
27
What is adrenal Cushing’s syndrome?
Adrenal tumour secreting glucocorticoids | May also secrete cortisol metabolites
28
What is the presentation of adrenal Cushing’s syndrome?
ACTH is suppressed Androgenic symptoms may be present - hirsutism, acne, greasy skin Virilising features in large tumours - androgenic alopecia, deep voices, clitoromegaly
29
What is the treatment for adrenal Cushing’s syndrome?
Adrenalectomy
30
What is the risk after an adrenalectomy?
Post-op hypoadrenalism risk due to contra-lateral adrenal suppression
31
What is primary hyperaldosteronism?
Excess production of aldosterone from adrenal gland
32
What is Conn’s syndrome?
Aldosterone-secreting adrenal adenoma
33
What is the commonest form of endocrine hypertension?
Primary hyperaldosteronism
34
What does primary hyperaldosteronism cause?
Hypertension and hypokalaemia High aldosterone and suppressed renin Scan shows adrenal adenoma or bilateral hyperplasia
35
How is Conn’s adenoma treated?
Surgery
36
How is bilateral hyperplasia treated?
Aldosterone antagonists - spironolactone/eplerinone
37
What is congenital adrenal hyperplasia?
Autosomal recessive Adrenal crisis and ambiguous genitalia Caused by a block in adrenal cortex pathway Presentation depends on enzyme defect
38
What does the lack of enzyme in congenital adrenal hyperplasia lead to?
Low cortisol and aldosterone | High male hormone (androgens)
39
Which enzyme is most commonly absent in congenital adrenal hyperplasia?
21-hydroxylase
40
What is the presentation of congenital adrenal hyperplasia?
``` Hypotension Hyponatraemia Hyperkalaemia Hypoglycaemia Virilisation ```
41
What is the treatment of congenital adrenal hyperplasia?
Treat adrenal crisis Determine sex of baby Long term GC and MC Corrective surgery
42
What is phaeochromocytoma?
Tumour of adrenal medulla
43
What is paraganglioma?
Extra-adrenal tumour- chromaffin tissue origin
44
What are the symptoms of phaeochromocytoma and paraganglioma?
``` Acute episodes Sweating Panic attacks Palpitations High or low BP Collapse ```
45
What happens in acute crisis of phaeochromocytoma and paraganglioma?
``` Hypertensive crisis Encephalopathy Hyperglycaemia Cardiac arrhythmias Sudden death ```
46
What are the investigations needed for phaeochromocytoma and paraganglioma?
24hr urine metanehrines 2-3 collections needed Plasma metanephrines
47
What is the management for phaeochromocytoma and paraganglioma?
Alpha blockade - phenocybenzamine Beta-blockade - bisoprolol Surgical excision

MEH (22 decks)

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