9- Adrenal Disorders

Question 1

Where is the spleen located and why is this significant

Answer 1

The SPLEEN is right next to the left adrenal gland
• So the spleen can easily be damaged during a left adrenalectomy.
• Therefore, the patient must be immunised
with Haemophilius Influenzae type b (HIB)
and pneumovax (pneumococcal vaccination
against several strains of Streptococcus pneumococcus)

Question 2

Where do the left and right renal veins drain into

Answer 2

Left adrenal vein drains into the renal vein and then into the inferior vena cava
• Right adrenal vein drains directly into the vena cava

Question 3

Describe the 4 layers of the adrenal cortex and what they produce

Answer 3

Glomerulosa - aldosterone
• Fasciculata - cortisol
• Reticularis - doesn’t really do anything, it’s a remnant
from evolution
• Adrenal Medulla - produces catecholamines (adrenaline,
noradrenaline)

Question 4

What is Addison’s disease

Answer 4

Occurs when your adrenal glands fail
• Can be caused by autoimmune disease where
the immune system wipes out the adrenal
cortex (commonest in the UK)
• TUBERCULOSIS of the adrenal glands
(commonest WORLDWIDE)
• Clinical features of Addison’s disease:
To try and make amends for the lack of cortisol, the pituitary starts secreting lots of ACTH and hence there is a large amount of MSH
You get low blood pressure because the adrenals aren’t producing aldosterone any more
Features of Addison’s Disease
• Increased pigmentation
• Autoimmune vitiligo may coexist
• Low Blood Pressure - due to lack of cortisol and aldosterone

Question 5

How should you treat someone with an addisonian crisis

Answer 5

Rehydrate with normal saline - FIRST STEP
• Give DEXTROSE to prevent hypoglycaemia which could be due to the glucocorticoid deficiency
• Give Hydrocortisone or another glucocorticoid medication

Question 6

What can excess cortisol cause

Answer 6

Impaired glucose tolerance (diabetes) - due to increased blood glucose
concentration
• Weight gain (increase fat, lose protein)
• Thin skin and easy bruising
• Striae (stretch marks)
• Proximal Myopathy (weakness of the large muscles)
• Mental changes (depression - steroids start to have an effect on the brain)
• Hypertension
• Fat Redistribution
• Moon Face
• Interscapular Fat Pad (‘buffalo pad’)
• Hirsuitism and acne - zona reticularis starts to produce a bit more testosterone

Question 7

What are the main causes of cushings

Answer 7

• Taking steroids by mouth
• Piuitary adenoma producing too much ACTH - Cushing’s DISEASE
• Ectopic ACTH - some lung cancer cells can start to produce ACTH (if you
remove the tissue, Cushing’s syndrome disappears)
• Adrenal adenoma or carcinoma

Question 8

What is the difference between Cushing’s syndrome and cushings disease

Answer 8

Cushing’s SYNDROME = a collection of symptoms which could have any cause
Moon face Striae Hypertension Thin skin etc.
• Cushing’s DISEASE = where the cause is known to be a PITUITARY ADENOMA

Question 9

What are some clinical signs of cushings

Answer 9

Thin skin
• Proximal myopathy
• Centripetal obesity (lemon on
sticks)
• Diabetes, hypertension and
osteoporosis
• Immunosuppression (reactivation
of TB)
• Moon face

Question 10

Describe features of CONNs syndrome

Answer 10

Aldosterone Producing Adenoma

• Tumour of the zona glomerulosa (which produces aldosterone)
• Aldosterone makes you retain sodium and lose potassium
• Hypertension
• Oedema
• Low blood potassium