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Endocrinology > Adrenal > Flashcards

Adrenal Flashcards

1
Q

Zones and hormones of adrenal gland

A
  1. Zona glomerulosa - Mineralocorticoid - Aldosterone
  2. Zona fasciculata - Glucocorticoid - Cortisol
  3. Zona reticularis - androgen - DHEA
  4. Medulla - Catecholamines - epi/norepinephrine
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2
Q

What is Cushings syndrome

A

Excess Cortisol

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3
Q

What is Cushing disease

A

Excess ACTH - pituitary abn
causing excess cortisol

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4
Q

Causes of Cushing syndrome

A
  1. Iatrogenic (steroid intake)
  2. Cushing disease (pituitary ACTH exces)
  3. Tumour/adrenal hyperplasia
  4. Oat cell lung CA - non-endocrine tumour releasing CRH (Corticotropin releasing hormone)
  5. Ectopic ACTH
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5
Q

C/F of Cushing syndrome (10)

A
  1. Central obesity
  2. Buffaloe hump
  3. Proximal muscle wasting
  4. Cushing facies - moon face
  5. Abdominal striae
  6. Thin skin
  7. Hypertension
  8. Hyperglycemia
  9. Osteoporosis
  10. Hirsutism - androgen release excess
  11. Hypokalemia - mineralocorticoid excess (not clinically significant)
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6
Q

Investigations, gold standard for cushing syndrome

A
  1. 24 hr urinary free cortisol - Gold standard
  2. Dexamethasone suppression test (done 1st)
  3. Salivary cortisol at 12am (normally low)
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7
Q

Dexamethasone suppression test

A

1mg dexa given at 11pm
Cortisol levels checked at 8 am
- Come back to normal level on normal pts

*Drugs interacting causing false results-
1. Rifampicin
2. Carbamazepine
3. Phenytoin

*Higher cortisol in stress - anorexia, bulimia, alcohol withdrawal, depression, starvation

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8
Q

Test to distinguish b/w high ACTH due to pituitary adenoma and ectopic ACTH release

A

High dose Dexa suppression test
Pituitary ACTH - suppressed
Ectopic ACTH - not suppressed

MRI - pituitary gland done continued with inferior petrosal sinus sampling
(or)
CT full body for Ectopic focus

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9
Q

In high cortisol cases, how do you recognise if the cause is adrenal gland

A

ACTH levels are low (feedback mechanism)
f/b
CT adrenal gland (hyperplasia/CA)

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10
Q

Unresectable adrenal tumour can be treated with which drugs

A
  1. Ketoconazole
  2. Metyrapone
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11
Q

What is Addisons disease

A

Low Cortisol … low aldosterone
D/t destruction of adrenal gland
Autoimmune mainly

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12
Q

C/F of Addisons disease

A
  1. Weakness
  2. Hypotension
  3. Hypoglycemia
  4. Hyperpigmentation of buccal mucosa, hard palate, skin of hand creases
  5. *Hyperkalemia, Hyponatremia, water loss
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13
Q

What is Cosyntropin

A

ACTH analogue

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14
Q

Screening test for Addisons disease

A

Cosyntropin 250 micrograms …
check cortisol after 30-60mins

Still low - Adrenal insufficiency
Primary if ACTH high (adrenal problem)
Secondary if ACTH low (pituitary problem)

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15
Q

Hyperaldosteronism symptoms

A

Hypokalemia related
Weakness, cramps

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16
Q

Primary and secondary hyperaldosteronism

A

Primary - adrenal adenoma
Ald high, Renin low (feedback inhibition)

Secondary - dehydration
Renin high … Ald high

17
Q

Pheochromocytoma Symptoms

A

Headache
sweating
palpitations
*HTN not reducing with medication

18
Q

Pheochromocytoma caused due to

A

Tumour of adrenal medulla (epi/norepinephrine)

19
Q

Pathology shows which kind of cells in pheochromocytoma

A

Chromaffin cells

20
Q

Rule of 10’s in Pheochromocytoma

A

10% Malignant
10% Bilateral
10% extra adrenal - bladder/Zuckerkandl organ (bifurcation of aorta)
10% Calcify
10% Kids

21
Q

Diagnosis of Pheochromocytoma

A

1.Best initial test
↑ free metanephrine level in plasma

  1. Confirmation: 24-hour urine collection
    *↑ vanillyl mandelic acid (breakdown of
    norepinephrine and epinephrine)
    *↑ metanephrines (more sensitive than
    VMA)
  2. Histology
    chromaffin cells with enlarged
    dysmorphic nuclei
  3. Adrenal CT MRI
  4. MIGB scan
22
Q

Rx for HTN in pheochromocytoma

A

Alpha blockers (prazocine)

Endocrinology (4 decks)

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