6) Hyperadrenal disorders

Question 1

What do the 2 parts of the adrenal glands make?

Answer 1

Adrenal cortex-cortisol (glucocorticoid) + aldosterone (mineralocorticoid)
Adrenal medulla-NA + A (cateocholamines)

Question 2

What is cushing’s syndrome?

Answer 2

Excess cortisol (all causes)

Question 3

What is cushing’s disease?

Answer 3

Excess cortisol (pituitary dependent)

Question 4

Clinical features of cushing’s?

Answer 4

Centripetal obesity
Moon face + buffalo hump
Hypertension + hypokalemia
Osteoporosis + diabetes

Question 5

4 possible causes of cushing’s:

Answer 5

Pituitary dependent
Ectopic ACTH-lung cancer
Adrenal adenoma
Taking too many steroids

Question 6

3 investigations to confirm cushing’s:

Answer 6

1) Urine cortisol levels-if high=cushings
2) Blood cortisol level
- cortisol levels should be hightest in the morning
- so you measure at midnight-if high=cushing’s
3) Low dose dexamethosone test-when a high dose of steroid is given cortisol levels should become 0
- if not 0=cushings

Question 7

What sort of rhythm does cortisol secretion follow?

Answer 7

Circadian

In cushing’s the circadian rhythm is lost

Question 8

When should cortisol levels be highest?

Answer 8

Morning

Question 9

2 ways to treat cushing’s with examples:

Answer 9

1) surgery-remove tumour

2) drugs-enzyme inhibitors e.g. metyrapone/ketoconazole

Question 10

What does cushing’s suppress and why is this a particular problem when it comes to treatment?

Answer 10

Immune system
We need immune system to be be strong for post op recovery
So we give drugs to lower cortisol before surgery

Question 11

What are the 3 main arms of steroid hormone synthesis starting from cholesterol:

Answer 11

1) Cortisol (glucocorticoid)
2) Aldosterone (mineralocorticoid)
3) Sex steroids

Question 12

Explain how Metyrapone treats Cushing’s syndrome and the side effects it causes:

Answer 12

Metyrapone=inhibits 11B-hydroxylase

• inhibits cortisol + corticosterone synthesis
• as cortisol + corticosterone aren’t produce there is reduced -ve feedback so more ACTH produced

Side effects:
Hirturism=as precursors all funnelled into sex steroid synthesis
Hypertension=as the products just before 11B-hydroxylase converts them have mineralocorticoid like effects

Question 13

Explain how ketoconazole treats Cushing’s syndrome and a side effect it has:

Answer 13

Ketoconazole=inhibits 17a-hydroxylase
-inhibits cortisol production

Side effect=liver damage

Question 14

What is Conn’s syndrome?

Answer 14

Excess aldosterone

Question 15

What type of disease is Conns?

Answer 15

Primary-issue with endocrine (adrenal) gland

Question 16

What causes Conn’s syndrome?

Answer 16

Adrenal tumour

Question 17

What is the difference between Cushing’s & Conn’s syndrome?

Answer 17

Cushing’s is treated using enzyme inhibitors to block cortisol production
Conn’s is treated using receptor antagonists (MR) to block aldosterone action

Question 18

2 examples of drugs used to treat Conn’s syndrome:

Answer 18

Mineralocorticoid receptor antagonists

Spirinolcatrone + epleronone

Question 19

What are phaeochromocytomas?

Answer 19

Adrenal medulla tumours (excess NA + A)

Question 20

What are the clinical features of phaeochromocytomas?

Answer 20

Hypertension-episodic
sweating
headache
sudden anxiety (due to high adrenaline)
huge tumour
nausea

Question 21

How are phaeochromocytomas treated?

Answer 21

Surgery-remove tumour