Adrenal

Question 1

Is discontinuation of exogenous CS a primary or secondary cause of adrenal insufficiency?

Answer 1

Secondary.

Question 2

What antibodies do you check for in autoimmune adrenalitis?

Answer 2

21 hydroxylase Ab

CYP21A2 antibody

Question 3

Someone is hypothyroid and then you start thyroxine but they come back shocked in one week- what has happened?

Answer 3

Coexisting adrenal insufficiency

Giving thyroxine has accelerated cortisol metabolism and precipitated adrenal crisis

Question 4

What is in autoimmune polyendocrine syndrome type 1?

Answer 4

Addisons
Hypoparathyroidism
Mucocutaneous candidiasis
Skin candida

Question 5

What is in autoimmune polyendocrine syndrome 2?

Answer 5

Addisons
DM1
Hypothyroidism

Question 6

If find adrenal, thyroid and gonadal failure, what does FSH tell you?

Answer 6

If high tells you probably not a pituitary problem

Would check 21-OH Ab, Anti TPO Ab and anti ovarian Ab to diagnose autoimmune polyglandular syndrome.

Question 7

Biochemical and clinical differences between primary and secondary adrenal insufficiency?

Answer 7

Skin- pigmented in primary due to the ACTH which will be high. Alabaster and low or normal ACTH in secondary.

Hyponatraemia more prominent in primary
Hyperkalaemia present in primary ABSENT IN SECONDARY
Primary get hypercalcaemia, secondary only occasionally
MORE hypoglycaemia in secondary
MORE hypovolaemia in primary

IN primary need to look for Autoimmune Polyendocrine syndrome
In secondary need to look for pituitary failure.

Question 8

What should you look for in any boy or young man with adrenal insufficiency?

Answer 8

X linked recessive disorders: adrenoleukodystrophy/adrenomyeloneuropathy

Diagnosis= elevated very long fatty acid chains.

Normally fist one is in kids, second is young man with spasticity and distal polyneuropathy.

Question 9

Describe the effect of liquorice on causing an apparent mineralocorticoid excess

Answer 9

block 11β-hydroxysteroid dehydrogenase type 2, in turn causing increased levels of cortisol

Question 10

List the 5 causes of apparent mineralocorticoid excess- low ald and renin in someone with hypertension, hypokalaemia and metabolic alkalosis

Answer 10

Exogenous mineralocorticoid
Cushing’s syndrome (production of mineralocorticoid compounds)
Liquorice (inhibits 11bHSD2–>more cortisol as not broken down)
CAH/11bHSD2 deficiency
Liddle (activating mutation in CT of sodium channel)