Adrenal

Question 1

Invx for Cushing

Answer 1

24hr urinary free coritisol
ACTH -?ACTH dependent
Can’t use DXM
MRI if found

Question 2

Management in preg- Cushing

Answer 2

Control HTN and DM
Unilateral adrenalectomy 2nd trimester if indicated
Pituitary- 2nd trimester if indicated
If surgery- must replace cortisol with cortisone

Question 3

Adrenal insuffienciency

Answer 3

Primary - high ACTH; addisons; adrenal origin

Secondary- from hypothalamus or pituitary, Low ACTH, usually post treatment with glucocorticoid

Question 4

Acute adrenal crisis

Answer 4

Shock
Hypotension
Hypoglycemia
Hyponatraemia
Hyperkalamia

Question 5

Phaeochromocytoma

Answer 5

90% arise in adrenal gland
3-36% metastatic
Some germline mutation

Question 6

Phaeochrom features

Answer 6

HTN
Plasma metanephrines
Proteinuria

Usually hard to distinguish from PET

Question 7

Conn’s syndrome

Answer 7

HTN

Hypokalamaeia

Question 8

CAH

Answer 8

AR
Serum 17OH progesterone accumulates
Need cortisone replacement
More prevelant in Akanashi Jews

Question 9

Clinical features of Addison’s disease

Answer 9

Weight loss
Poor wellbeing
Vomiting
Lethargy
Postural hypotension
Hyperpigmentation
Hyponatraemia
Hyperkalaemia
Hypoglycaemia