9 - Adrenal Disorders

Question 1

What is adrenal failure called?

Answer 1

Addison’s

Question 2

What is excess cortisol called?

Answer 2

Cushing’s

Question 3

Draw the anatomy of the adrenal gland and blood vessels associated.

Answer 3

Drawing

Question 4

Why are operations on the adrenal glands dangerous?

Answer 4

Left adrenal is very near spleen which can bleed out a lot.

Before operation patient is given vaccinations incase of blood loss (HIB)

Question 5

Where is aldosterone made?

Answer 5

Zona glomerulosa

Question 6

Where is adrenaline made?

Answer 6

Medulla

Question 7

Where is cortisol made?

Answer 7

Fasciculata and reticularis.

Question 8

How many carbons does cholesterol have?

Answer 8

27

Question 9

Draw the HPA axis.

Answer 9

Drawing.

Question 10

What does POMC stand for and what is it?

Answer 10

Pro-opio-melanocortin
Made in pituitary
Precursor protein that is cleaved to form smaller peptides (ACTH and MSH and endorphins)

Question 11

What does MSH stand for?

Answer 11

Melanocyte-stimulating hormone

Question 12

Why will people with high levels of ACTH be tanned?

Answer 12

Because ACTH and MSH come from the same precursor.

MSH causes tanning.

Question 13

What is Addison’s disease?

Answer 13

Primary adrenal failure.
Autoimmune disease - immune system takes out adrenal cortex.
Can be caused by tuberculosis of the adrenal gland (more common worldwide).

Question 14

What hormones are secreted in someone with Addison’s?

Answer 14

POMC - ACTH and MSH

ACTH produced as pituitary senses no cortisol.

Question 15

Clinical signs of Addison’s?

Answer 15

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

Question 16

Treatment of Addison’s?

Answer 16

Give them saline (sodium)
Give them dextrose (glucose) i.v. to prevent hypoglycaemia.
Give hydrocortisone / another glucocorticoid / prednisolone. To replace missing hormone.

Question 17

What are the biological effects of EXCESS cortisol & what is this called? (Clinical signs)

Answer 17

Cushing’s

Impaired glucose tolerance (type II diabetes)

Proximal myopathy (muscle weakness)

Centripetal Obesity

Hypertension, osteoporosis

Immunosuppression (TB)

Question 18

What other obvious symptoms may a patient with Cushing’s notice?

Answer 18

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)

Question 19

What can Cushing’s be caused by?

Answer 19

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)

Question 20

What is the difference between Cushing’s Syndrome and Cushing’s disease?

Answer 20

Syndrome - Any cause

Disease - Cause is known to be pituitary adenoma.

Question 21

What are the side effects of steroids?

Answer 21

Hypertension
Diabetes
Osteoporosis
Reactivation of infection (TB)
Easy bruising
Poor wound healing, thin skin

EXACTLY THE SAME AS CUSHING’S

Question 22

What happens if a glomerulosa cell gets a tumour?

Answer 22

Too much aldosterone will be made.

Conn’s syndrome

Question 23

Symptoms of Conn’s syndrome?

Answer 23

Hypertension (difficult to treat as requires more steroids)
Oedema
(Retain sodium - swelling)
Lose potassium