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REGUB > 21. Adrenal and Parathyroid Pathology > Flashcards

21. Adrenal and Parathyroid Pathology Flashcards

1
Q

What is the most common cause of cushing’s syndrome?

A

Exogenous steroids

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2
Q

What are the adrenal causes of cushing’s syndrome?

A

Adenoma/carcinoma

Nodular hyperplasia

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3
Q

What are the paraneoplastic causes of cushing’s syndrome?

A

Small cell
Carcinoid
Medullary of thyroid
Islet cell of pancreas

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4
Q

Why should care be taken when taking a patient off exogenous steroids?

A

Steroids cause adrenal glands to atrophy so they can’t meet the demand by themselves

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5
Q

What are the clinical features of Cushing’s syndrome?

A

Hypertension
Weight gain, moon face
Hyperglycaemia
Fragile skin, osteoporosis

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6
Q

What are the effects of hyperaldosteronism?

A

Hypernatraemia
Hypokalaemia
Hypertension

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7
Q

How can primary and secondary hyperaldosteronism be differentiated?

A

Primary: shows reduced plasma renin as suppressed RAAS

Renin increased in secondary

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8
Q

What are the causes of primary hyperaldosteronism?

A

Conn’s syndrome: adrenocortical adenoma
Adenocortical hyperplasia
Glycocorticoid-suppressible hyperaldosteronism

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9
Q

What is the treatment for hyperaldosteronism?

A

Surgically remove adenomas

Spironolactone if hyperplasia

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10
Q

Which hormones are produced in each part of the adrenal cortex?

A

Glucocorticoids= fasciculata
Mineralocorticoids= glomerulosa
sex hormones= reticularis

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11
Q

What are the causes of secondary hyperaldosteronism?

A

CCF
Renal artery stenosis
Low albumin
Pregnancy

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12
Q

What enzyme is typically deficient in adrenogenital disorders?

A

21-hydroxylase which usually converts progesterone to 11-deoxycorticosterone

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13
Q

What are the causes of an acute adrenal crisis?

A

Addison’s with an additional stressor
Rapid withdrawal from exogenous steroids
Massive adrenal haemorrhage

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14
Q

What are the symptoms of an acute adrenal crisis?

A

Vomiting
Abdominal pain
Low BP
Coma and collapse

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15
Q

What is Waterhouse Friedriechsen Syndrome?

A

Bilateral adrenal haemorrhage a/w neisseria meningitidis sepsis

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16
Q

What is Addison’s disease?

A

Progressive destruction of the adrenal cortex

17
Q

What are the causes of Addison’s disease?

A

Autoimmune adrenalitis
Infections
Metastatic carcinoma

18
Q

What are the clinical features of Addison’s disease?

A

Progressive weakness and fatigue
Anorexia, nausea, vomiting and weight loss
Hyperpigmentation of skin
High K+, low Na+, BP and glucose

19
Q

What is the appearance of adenomas in the adrenal cortex?

A

Well circumscribed
Yellow due to lipid content
Haemorrhage, cystic degeneration, calcification

20
Q

Where do adrenal carcinomas spread to?

A

Adrenal vein, vena cava and lymphatics

Mets to lungs

21
Q

What proportion of phaeochromocytomas are familial?

A

1/4

MEN and von Hippel Lindau

22
Q

What is a paraganglioma?

A

Phaeochromocytoma outside the adrenal gland, typically in the carotid bodies

23
Q

What are the clinical features of a phaeochromocytoma?

A

Hypertension, tachycardia, palpitations, headaches, sweating, tremor, abdomen and chest pain
Catecholamine cardiomyopathy

24
Q

How is a phaeochromocytoma diagnosed?

A

24 hour urine catecholamines

for VMA and metanephrines

25
Q

What name is given to supporting cells in the medulla?

A

Sustentacular cells

26
Q

What are the causes of hyperparathyroidism?

A

Adenoma
Hyperplasia
Carcinoma

27
Q

What are the causes of secondary hyperparathyroidism?

A

Renal failure

Chronic low calcium

28
Q

What are the causes of hypoparathyroidism?

A

Surgical removal in thyroidectomy
DiGeorge syndrome
Autoimmune against Ca++ sensing receptors in the gland
Familial hypoparathyroidism

29
Q

What type of inheritance are MEN syndromes?

A

AD

30
Q

Which gene is associated with MEN 1?

A

MEN 1 gene on chromosome 2

31
Q

Which neoplasms are associated with MEN 1?

A

Parathyroid
Pituitary
Pancreatic islet cells

32
Q

What gene is associated with MEN 2?

A

RET proto-oncogene

33
Q

What neoplasms are associated with MEN 2A?

A

Medullary carcinoma of thyroid
Phaeochromocytoma
Parathyroid hyperplasia

34
Q

Name a variant of MEN 2A?

A

Familial medullary thyroid cancer

35
Q

What conditions are associated with MEN 2B?

A

Medullary carcinoma of the thyroid
Phaeochromocytoma
Extra-endocrine manifestations eg. Marfan

36
Q

What treatment is suggested if a patient has a RET mutation?

A

Prophylactic thyroidectomy

REGUB (31 decks)

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