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MS4 - Endocrine > Adrenal > Flashcards

Adrenal Flashcards

1
Q

Functions of adrenal cortex

A

Glucocorticoids

Mineralocorticoids

Androgens

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2
Q

Functions of glucocorticoids

A

Affects carbohydrate, lipid and protein metabolism

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3
Q

Functions of mineralocorticoids (aldosterone)

A

Renin angiotensin aldosterone system

Activates Na/K pump in distal tubule

Reabsorption of Na and water

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4
Q

Stimualtion of glucocorticoid and androgen release

A

CRF from hypothalamus

ACTH from pituitary

Cortisol and androgen from adrenal glands

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5
Q

CRF

A

Corticotrophin releasing factor

Released from hypothalamus

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6
Q

Cushing’s syndrome

A

Clinical state

Excess glucocorticoid

Loss of normal feedback mechanisms

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7
Q

When is cortisol secretion usually highest

A

On waking up

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8
Q

Causes of Cushing’s syndrome

A

Oral steroids

Cushing’s disease

Ectopic ACTH production

Adrenal adenoma

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9
Q

Cushing’s disease definition

A

ACTH secreting pituitary adenoma

Leads to bilateral adrenal hyperplasia

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10
Q

Causes of ectopic ACTH production

A

Small cell lung cancer

Carcinoid tumours

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11
Q

Sx of Cushing’s syndrome

A

Weight gain

Depression

Lethargy

Hirsutism

Proximal muscle weakness

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12
Q

Signs of Cushing’s syndrome

A

Moon face

Buffalo hump

Striae / bruises

HTN

Impaired glucose tolerance

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13
Q

Specific sign of ectopic ACTH production causing Cushing’s syndrome

A

Skin pigmentation

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14
Q

Ix for Cushing’s syndrome

A

Raised plasma cortisol

Overnight dexamethasome suppression test

24 hr urinary free cortisol

48 hr dexamethasone suppression test

48 hr high dose dexamethasone suppression test

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15
Q

Overnight dexamethasome suppression test

A

Dexamethasone 1 mg at midnight

Serum cortisol at 8 am

Normal: cortisol < 50 mmol/L

Cushing’s: failure to suppress cortisol

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16
Q

48 hr dexamethasone suppression test

A

Dexamethasone 0.5mg/6hrs for 2 days

Serum cortisol at 0 and 48 hrs

Cushing’s: failure to suppress cortisol

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17
Q

48 hr high dose dexamethasone suppression test

A

Dexamthasone 2mg/6hrs

Pituitary cause: cortisol suppression

Other cause: little suppression

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18
Q

Mx of Cushing’s disease

A

Remove pituitary adenome

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19
Q

Mx of iatrogenic Cushing’s syndrome

A

Stop steroids

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20
Q

Mx of ectopic ACTH producing Cushing’s syndrome

A

Remove causative tumour

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21
Q

Mx of adrenal adenoma causing Cushing’s syndrome

A

Adrenalectomy

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22
Q

Nelson’s syndrome

A

Skin hyperpigmentation

Post adrenalectomy

Loss of negative feedback

Raised ACTH

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23
Q

Addison’s disease definition

A

Primary adrenocortical insufficiency

Cortisol and Aldosterone deficiency

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24
Q

Causes of Addison’s disease

A

Autoimmune

TB

Adrenal metastases

Opportunistic infections in HIV

Adrenal haemorrhage

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25
Q

Causes of adrenal haemorrhage

A

Waterhouse-Friderichsen syndrome

Antiphospholipid syndrome

SLE

26
Q

Waterhouse-Friderichsen syndrome definition

A

Bilateral adrenal cortex haemorrhage

27
Q

Most common cause of Waterhouse-Friderichsen syndrome

A

Rapidly deteriorating sepsis

28
Q

Mx of Waterhouse-Friderichsen syndrome

A

Abx (ceftriaxone)

Hydrocortisone

29
Q

Sx of Addison’s disease

A

Weight loss

Fatigue

Depression

N/V

Abdo pain

Diarrhoea/Constipation

30
Q

Signs of Addison’s disease

A

Hyperpigmentation

Postural hypotension

Hyperkalaemia

Hypoglycaemia

31
Q

Diagnosis of Addison’s disease

A

Short synacthen test

(synthetic ACTH)

32
Q

Short synacthen test

A

Plasma cortisol before and 30 mins after synthetic ACTH (250 microg)

Addison’s excluded if 30 min cortisol > 550 nmol/L

33
Q

Causes of false negative in short synacthen test

A

Pregnancy or COCP

Due to raised cortisol-binding globulin

34
Q

Mx of Addison’s disease

A

Hydrocortisone

Fludrocortisone

35
Q

Sick day rules for steroid use

A

Double steroid dose in febrile illness, injury or stress

36
Q

Causes of secondary adrenal insufficiency

A

Iatrogenic

Hypothalamic-pituitary disease (rare)

37
Q

Iatrogenic cause of secondary adrenal insufficiency

A

Long term steroid use

Inhibits pituitary adrenal axis

Sudden withdrawal of steroids

38
Q

Primary hyperaldosteronism definition

A

Excess production of aldosterone

Independent of RAAS

Na and water retention

39
Q

Sx of primary hyperaldosteronism

A

Hypokalaemia

HTN

Weakness

Cramps

Paraesthesia

40
Q

Causes of primary hyperaldosteronism

A

Conn’s syndrome

Bilateral adrenocortical hyperplasia

41
Q

Conn’s syndrome definition

A

Solitary aldosterone producing adenoma

42
Q

Mx of Conn’s syndrome

A

Spironolactone

Adrenalectomy

43
Q

Mx of bilateral adrenocortical hyperplasia

A

Spironolactone

Aldosterone receptor antagonist

44
Q

Aldosterone receptor antagonist examples

A

Amiloride

Eplerenone

45
Q

Secondary hyperaldosteronism definition

A

High aldosterone due to high renin

46
Q

Causes of secondary hyperaldosteronism

A

Reduced renal perfusion

Renal artery stenosis

CCF

Diuretics

47
Q

Bartter’s syndrome definition

A

Autosomal recessive

Congenital salt wasting

48
Q

Bartter’s syndrome pathology

A

Defective channel in loop of Henle

Na and Cl leak

49
Q

Bartter’s syndrome presentation

A

Presents in childhood

Failure to thrive

Hypokalaemia / Alkalosis

Polyuria / Polydipsia

Normal BP

50
Q

Mx of Bartter’s syndrome

A

K replacement

NSAIDs (inhibits prostaglandins)

ACEi

51
Q

Phaeochromocytoma definition

A

Rare chatecholamine producing tumour

52
Q

Phaeochromocytoma cell origins

A

From sympathetic paraganglia cells

(Collections of chromaffin cells)

Usually in adrenal medulla

53
Q

Function of adrenal medulla

A

Catecholamines:

Adrenaline

Noradrenaline

54
Q

Classic triad of phaeochromocytoma

A

Episodic headache

Sweating

Tachycardia

+/- HTN

55
Q

Ix for phaeochromocytoma

A

3 x 24 hr urine for free metadrenaline

CT/MRI

56
Q

Metadrenaline

A

Metabolite of adrenaline

57
Q

Mx of phaeochromocytoma

A

Surgery

58
Q

Precipitating factors to Addisonian crisis

(Acute Adrenal Crisis)

A

Sepsis / Infection

Trauma

Surgery

Missed medication

59
Q

Sx of Addisonian crisis

A

Shock:

Tachycardia

Postural hypotension

Oligouria

Confusion

Weak

60
Q

Ix for Addisonian crisis

A

If suspected, treat before biochemical results

Serum cortisol and ACTH

U+Es for Na and K

61
Q

Mx of Addisonian crisis

A

Hydrocortisone 100mg

IV fluid

Monitor blood glucose

Sepsis screen and Rx

MS4 - Endocrine (7 decks)

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