Adrenal Flashcards
Name the layers of the adrenal cortex and what they secrete
Glomerulosa: mineralocorticoid aldosterone
Fasciculata: glucocorticoid cortisol
Reticularis: DHEA androgen
(pneumonic GFR)
What is secreted by the adrenal medulla?
Adrenaline/ noradrenaline
Cortisol secretion is stimulated by what hormone?
ACTH
What is the action of aldosterone?
Reabsorb sodium for increasing plasma volume for >BP
What is the commonest cause of hypoadrenalism?
Addison’s disease
Addison’s disease is autoimmune primary adrenal cortex failure – true or false
True
In Addison’s disease, high ACTH interferes with secretion of what other hormone? What symptom does this cause?
MSH melanocyte stimulating hormone
Buccal/palmar hyperpigmentation
Addison’s disease presentation
- weight loss or gain
- what food craving?
- HTN or postural hypotension
- lethargy or increased energy
Weight loss Salty food craving Postural hypotension Lethargy (Also causes diarrhea)
Addison’s disease biochemistry
- low or high Na
- low or high K
- low or high BG
Low Na
High K
Low BG
How is Addison’s disease diagnosed?
Synacthen test - artificial ACTH - normal if see rise in cortisol
What is the management of Addison’s disease?
Hydrocortisone replaces cortisol, fludrocortisone replaces aldosterone
What is primary hyperaldosteronism also known as?
Conn’s syndrome
What is the cause of Conn’s syndrome?
Idiopathic bilateral adrenal hyperplasia or unilateral adenoma in glomerulosa secretes aldosterone
How does Conn’s syndrome typically present?
Resistant hypertension
Conn’s syndrome biochemistry
- low or high Na
- low or high K
Normal Na
Low K
What tests are done for Conn’s syndrome?
Saline suppression test and aldosterone renin ratio
Is aldosterone renin ratio high or low in Conn’s syndrome?
High
What is the management of concentration due to a unilateral adenoma secreting aldosterone?
Laparoscopic removal
How are Conn’s syndrome due to an adenoma or bilateral hyperplasia differentiated on investigations?
CT
What type of imaging is best for viewing an adrenal adenoma?
CT
What is the management of Conn’s syndrome due to bilateral adrenal hyperplasia?
Spironolactone (aldosterone antagonist
Phaeochromocytoma: tumour of _____ cells, secrete _____
Phaeochromocytoma: tumour of CHROMAFFIN cells, secrete CATECHOLAMINE
Are symptoms constant or intermittent in a pheochromocytoma?
Intermittent
due to intermittent catecholamine secretion
Pheochromocytoma presentation:
- Facial flushing or pallor
- Postural hypotension or resistant hypertension
- Headache or abdominal pain
Pallor
Resistant hypertension
Headache
What is the management of pheochromocytoma?
Alpha block phenoxybenzamine
Then beta blocker
Then surgery
What is the 10% rule of pheochromocytoma?
10% malignant
10% bilateral
10% genetic (eg MEN2, VHL)
What scan is done for pheochromocytoma to exclude malignancy?
Nuclear medicine MIBG scan
