9 - Adrenal Disorders Flashcards
What is adrenal failure called?
Addison’s
What is excess cortisol called?
Cushing’s
Draw the anatomy of the adrenal gland and blood vessels associated.
Drawing
Why are operations on the adrenal glands dangerous?
Left adrenal is very near spleen which can bleed out a lot.
Before operation patient is given vaccinations incase of blood loss (HIB)
Where is aldosterone made?
Zona glomerulosa
Where is adrenaline made?
Medulla
Where is cortisol made?
Fasciculata and reticularis.
How many carbons does cholesterol have?
27
Draw the HPA axis.
Drawing.
What does POMC stand for and what is it?
Pro-opio-melanocortin
Made in pituitary
Precursor protein that is cleaved to form smaller peptides (ACTH and MSH and endorphins)
What does MSH stand for?
Melanocyte-stimulating hormone
Why will people with high levels of ACTH be tanned?
Because ACTH and MSH come from the same precursor.
MSH causes tanning.
What is Addison’s disease?
Primary adrenal failure.
Autoimmune disease - immune system takes out adrenal cortex.
Can be caused by tuberculosis of the adrenal gland (more common worldwide).
What hormones are secreted in someone with Addison’s?
POMC - ACTH and MSH
ACTH produced as pituitary senses no cortisol.
Clinical signs of Addison’s?
NO CORTISOL
NO ALDOSTERONE
Skin pigmentation Vitiligo (immune system takes out skin cells, patches of skin with no colour) Weight loss Muscle weakness (loosing sodium -salt) Blood pressure falls Atrophy of adrenal gland
Treatment of Addison’s?
Give them saline (sodium)
Give them dextrose (glucose) i.v. to prevent hypoglycaemia.
Give hydrocortisone / another glucocorticoid / prednisolone. To replace missing hormone.
What are the biological effects of EXCESS cortisol & what is this called? (Clinical signs)
Cushing’s
Impaired glucose tolerance (type II diabetes)
Proximal myopathy (muscle weakness)
Centripetal Obesity
Hypertension, osteoporosis
Immunosuppression (TB)
What other obvious symptoms may a patient with Cushing’s notice?
Fat redistribution (moon face)
Buffalo hump (interscapular fat pad)
Striae (stretch marks)
Hirsutism (facial hair & acne)
Weight gain (more fat & lose protein)
Thin skin & easy bruising, poor wound healing
Mental changes (depression)
What can Cushing’s be caused by?
Excess of cortisol or other glucocorticoid.
- Tumour (adenoma or carcinoma) in adrenal gland = making more cortisol
- Taking oral steroids (e.g. prednisolone) = more ACTH
- Pituitary adenoma (making ACTH)
- Ectopic (in the wrong place) ACTH (lung cancer)
What is the difference between Cushing’s Syndrome and Cushing’s disease?
Syndrome - Any cause
Disease - Cause is known to be pituitary adenoma.
What are the side effects of steroids?
Hypertension Diabetes Osteoporosis Reactivation of infection (TB) Easy bruising Poor wound healing, thin skin
EXACTLY THE SAME AS CUSHING’S
What happens if a glomerulosa cell gets a tumour?
Too much aldosterone will be made.
Conn’s syndrome
Symptoms of Conn’s syndrome?
Hypertension (difficult to treat as requires more steroids)
Oedema
(Retain sodium - swelling)
Lose potassium
