Adrenal

Question 1

Name the layers of the adrenal cortex and what they secrete

Answer 1

Glomerulosa: mineralocorticoid aldosterone
Fasciculata: glucocorticoid cortisol
Reticularis: DHEA androgen
(pneumonic GFR)

Question 2

What is secreted by the adrenal medulla?

Answer 2

Adrenaline/ noradrenaline

Question 3

Cortisol secretion is stimulated by what hormone?

Answer 3

ACTH

Question 4

What is the action of aldosterone?

Answer 4

Reabsorb sodium for increasing plasma volume for >BP

Question 5

What is the commonest cause of hypoadrenalism?

Answer 5

Addison’s disease

Question 6

Addison’s disease is autoimmune primary adrenal cortex failure – true or false

Answer 6

True

Question 7

In Addison’s disease, high ACTH interferes with secretion of what other hormone? What symptom does this cause?

Answer 7

MSH melanocyte stimulating hormone

Buccal/palmar hyperpigmentation

Question 8

Addison’s disease presentation

• weight loss or gain
• what food craving?
• HTN or postural hypotension
• lethargy or increased energy

Answer 8

Weight loss
Salty food craving
Postural hypotension
Lethargy
(Also causes diarrhea)

Question 9

Addison’s disease biochemistry

• low or high Na
• low or high K
• low or high BG

Answer 9

Low Na
High K
Low BG

Question 10

How is Addison’s disease diagnosed?

Answer 10

Synacthen test - artificial ACTH - normal if see rise in cortisol

Question 11

What is the management of Addison’s disease?

Answer 11

Hydrocortisone replaces cortisol, fludrocortisone replaces aldosterone

Question 12

What is primary hyperaldosteronism also known as?

Answer 12

Conn’s syndrome

Question 13

What is the cause of Conn’s syndrome?

Answer 13

Idiopathic bilateral adrenal hyperplasia or unilateral adenoma in glomerulosa secretes aldosterone

Question 14

How does Conn’s syndrome typically present?

Answer 14

Resistant hypertension

Question 15

Conn’s syndrome biochemistry

• low or high Na
• low or high K

Answer 15

Normal Na

Low K

Question 16

What tests are done for Conn’s syndrome?

Answer 16

Saline suppression test and aldosterone renin ratio

Question 17

Is aldosterone renin ratio high or low in Conn’s syndrome?

Answer 17

High

Question 18

What is the management of concentration due to a unilateral adenoma secreting aldosterone?

Answer 18

Laparoscopic removal

Question 19

How are Conn’s syndrome due to an adenoma or bilateral hyperplasia differentiated on investigations?

Answer 19

CT

Question 20

What type of imaging is best for viewing an adrenal adenoma?

Answer 20

CT

Question 21

What is the management of Conn’s syndrome due to bilateral adrenal hyperplasia?

Answer 21

Spironolactone (aldosterone antagonist

Question 22

Phaeochromocytoma: tumour of _____ cells, secrete _____

Answer 22

Phaeochromocytoma: tumour of CHROMAFFIN cells, secrete CATECHOLAMINE

Question 23

Are symptoms constant or intermittent in a pheochromocytoma?

Answer 23

Intermittent

due to intermittent catecholamine secretion

Question 24

Pheochromocytoma presentation:

• Facial flushing or pallor
• Postural hypotension or resistant hypertension
• Headache or abdominal pain

Answer 24

Pallor
Resistant hypertension
Headache

Question 25

What is the management of pheochromocytoma?

Answer 25

Alpha block phenoxybenzamine
Then beta blocker
Then surgery

Question 26

What is the 10% rule of pheochromocytoma?

Answer 26

10% malignant
10% bilateral
10% genetic (eg MEN2, VHL)

Question 27

What scan is done for pheochromocytoma to exclude malignancy?

Answer 27

Nuclear medicine MIBG scan