Adrenal

Question 1

What is this a presentation of?
Weight gain, mood change, proximal weakness, irregular menses, hirsutism, erectile dysfunction, acne, central obesity, moon face, buffalo hump, skin and muscle atrophy, bruises, purple abdominal striae, osteoporosis, hypertension, diabetes mellitus.

Answer 1

Cushing’s disease

Question 2

What is the main cause of Cushing’s syndrome?

Answer 2

Exogenous steroid use

Pituitary tumour - Cushing’s disease

Question 3

What is the diagnostic test for Cushing’s syndrome?

Answer 3

Overnight dexamethasone suppression - cortisol is not suppressed if Cushing’s syndrome is present

Question 4

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

Answer 4

1. Cushing’s syndrome - any condition causing adrenal gland to produce excessive cortisol
2. Cushing’s disease - when a pituitary tumour secretes excessive ACTH

Question 5

How can you localise the cause of Cushing’s syndrome?

Answer 5

1. Measure ACTH, if undetectable, most likely adrenal tumour (perform MRI).
2. If ACTH is detectable, perform CRH test - cortisol rises with pituitary disease but not with ectopic ACTH.

Question 6

What is this a presentation of?

Lean, tanned, tired, tearful, weakness, anorexia, faints, depression, N&V, abdominal pain, postural hypotension.

Answer 6

Addison’s disease

Question 7

What are the two types of Addison’s disease and what causes them?

Answer 7

1. Primary adrenal insufficiency - autoimmune, TB, adrenal metastases.
2. Secondary - iatrogenic and withdrawal of steroids, hypothalamic-pituitary disease.

Question 8

What is the effect of Addison’s disease on these blood components?

1. Sodium
2. Potassium
3. Glucose
4. Calcium
5. RBCs

Answer 8

1. Hyponatraemia
2. Hyperkalaemia
3. Hypoglycaemia
4. Hypercalcaemia
5. Anaemia

Question 9

How can you diagnose Addison’s disease?

Answer 9

1. Short ACTH test
2. 9am ACTH high in primary, low in secondary
3. 21-hydroxylase adrenal antibodies +ve in 80%

Question 10

What is the treatment for Addison’s disease?

Answer 10

1. Hydrocortisone TDS and fludrocortisone OD

2. Double glucocorticoids during illness, injury or stress.

Question 11

How does Addisonian crisis present and what causes it?

Answer 11

1. Tachycardia, hypotension, Addison’s symptoms, hyperkalaemic metabolic acidosis.
2. Sick day rules not followed with medication, missed dose, infection, trauma, surgery.

Question 12

What is the treatment for Addisonian crisis?

Answer 12

100mg IV hydrocortisone, IV fluids, monitor CBG