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Gen Med (Endocrine) > Adrenal - Basic Science & Hyperfunction > Flashcards

Adrenal - Basic Science & Hyperfunction Flashcards

1
Q

What 3 things are produced in the adrenal cortex?

A

Glucocorticoids, mineralocorticoids and androgens

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2
Q

What is the main glucocorticoid hormone produced by the adrenal cortex?

A

Cortisol

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3
Q

What is the main mineralocorticoid hormone produced by the adrenal cortex?

A

Aldosterone

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4
Q

What type of cells are found in the adrenal medulla?

A

Chromaffin cells

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5
Q

What is produced by the adrenal medulla? Give two examples.

A

Catecholamines e.g. adrenaline and noradrenaline

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6
Q

The synthesis of all the corticosteroids in the adrenal cortex begins with what?

A

Cholesterol

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7
Q

Which type of steroid hormone is produced in the zona glomerulosa of the adrenal cortex?

A

Mineralocorticoids

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8
Q

What regulates mineralocorticoid activity?

A

Angiotensin II (RAAS) and K+ level

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9
Q

Which type of steroid hormone is produced in the zona fasciculata of the adrenal cortex?

A

Glucocorticoids

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10
Q

Which type of steroid hormone is produced in the zona reticularis of the adrenal cortex?

A

Androgens

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11
Q

What regulates glucocorticoid activity?

A

ACTH

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12
Q

What regulates androgen activity?

A

ACTH

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13
Q

What hormone is released from the hypothalamus in the hypothalamic-pituitary-adrenal axis?

A

Corticotropin releasing hormone

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14
Q

What hormone is released from the pituitary gland in the hypothalamic-pituitary-adrenal axis?

A

ACTH

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15
Q

RAAS is a major regulator of aldosterone production. It is activated in response to what?

A

Decreased blood pressure

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16
Q

What is the effect of aldosterone?

A

Increase sodium reabsorption, and increase hydrogen and potassium excretion

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17
Q

Are corticosteroid receptors intra or extracellular?

A

Intracellular

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18
Q

What is the name for the clinical state of chronic glucocorticoid excess?

A

Cushing’s syndrome

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19
Q

When is cortisol usually at its highest and lowest levels in the normal circadian rhythm?

A

Usually lowest at midnight and highest upon waking

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20
Q

What is the most common cause of Cushing’s syndrome?

A

Use of oral steroids

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21
Q

What is the most common endogenous cause of Cushing’s syndrome?

A

Cushing’s disease (ACTH secreting pituitary adenoma)

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22
Q

What are the two main ACTH dependent (high ACTH) causes of Cushing’s syndrome?

A

Cushing’s disease and ectopic ACTH production

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23
Q

What are the two main ACTH independent (low ACTH) causes of Cushing’s syndrome?

A

Adrenal pathology (adenoma/hyperplasia) and iatrogenic steroid use

24
Q

What effect does Cushing’s syndrome have on blood pressure?

A

Hypertension

25
Q

What effect does Cushing’s syndrome have on blood glucose levels?

A

Hyperglycaemia

26
Q

If individuals with Cushing’s syndrome have an acid-base disorder, what is this most likely to be?

A

Hypokalaemic metabolic alkalosis

27
Q

What is the first line screening test for Cushing’s syndrome?

A

Overnight dexamethasone suppression test

28
Q

In the overnight dexamethasone suppression test, 1mg of dexamethasone is given at midnight and a cortisol level is taken at 8am. If the individual has Cushing’s syndrome, the cortisol level will be greater than what?

A

50nmol/L

29
Q

If an overnight dexamethasone suppression test is not suitable, what is another screening test that can be used for Cushing’s syndrome?

A

24h urinary free cortisol

30
Q

A normal 24h urinary free cortisol would be less than what value?

A

280nmol/L

31
Q

Once a screening test has confirmed Cushing’s syndrome, what investigation should be done next to determine between ACTH dependent and independent causes?

A

9am and midnight plasma ACTH and cortisol

32
Q

What is the first line diagnostic test for Cushing’s syndrome?

A

48h low dose dexamethasone suppression test

33
Q

How much dexamethasone is given every 6 hours in the low and high dose dexamethasone suppression tests?

A

Low = 0.5mg / high = 2mg

34
Q

When performing 48h dexamethasone suppression tests, when should plasma cortisol levels be measured?

A

At time 0, and 6 hours after the last dose

35
Q

In individuals with Cushing’s syndrome, in the 48h low dose dexamethasone suppression test, plasma cortisol levels will be greater than what 6 hours after the last dose?

A

50nmol/L

36
Q

What is the advantage of the 48h high dose dexamethasone suppression test over the low dose version?

A

High dose can differentiate between pituitary and non-pituitary causes of Cushing’s syndrome

37
Q

If cortisol is suppressed after the 48h high dose dexamethasone suppression test, this suggests that the pathology is where?

A

Pituitary gland

38
Q

If cortisol is not suppressed after the 48h high dose dexamethasone suppression test, this suggests that the pathology is where?

A

Adrenal gland or ectopic

39
Q

If ACTH levels are low in someone with Cushing’s syndrome, what is the first line imaging investigation?

A

Adrenal CT

40
Q

If ACTH levels are low in someone with Cushing’s syndrome but there is no mass on adrenal CT, what investigations could be tried next?

A

Adrenal vein sampling or adrenal scintigraphy

41
Q

If tests indicate that Cushing’s syndrome is likely of pituitary origin, what imaging investigation should be considered?

A

Pituitary MRI

42
Q

If tests indicate that Cushing’s syndrome is likely of ectopic origin, what imaging investigation should be considered?

A

Contrast CT chest/abdo/pelvis

43
Q

If corticotropin releasing hormone causes cortisol to rise in someone with Cushing’s syndrome, the underlying cause is most likely what?

A

Pituitary adenoma (Cushing’s disease)

44
Q

If corticotropin releasing hormone doesn’t cause cortisol to rise in someone with Cushing’s syndrome, then the underlying cause is most likely what?

A

Ectopic ACTH production

45
Q

How should Cushing’s syndrome caused by a pituitary adenoma be treated?

A

Trans-sphenoidal surgical removal of the adenoma

46
Q

How should Cushing’s syndrome caused by an adrenal adenoma be treated?

A

Adrenalectomy

47
Q

Untreated Cushing’s syndrome has increased mortality because of what?

A

Increased risk of vascular disease

48
Q

Pseudo-Cushing’s syndrome is most commonly caused by one of what two things?

A

Alcohol excess or severe depression

49
Q

What are the 3 main features of primary hyperaldosteronism?

A

Hypertension, hypokalaemia, alkalosis

50
Q

What are the two main causes of primary hyperaldosteronism?

A

Adrenal adenoma (Conn’s syndrome) or adrenal hyperplasia

51
Q

What is the first line investigation for primary hyperaldosteronism?

A

Plasma aldosterone to renin ratio

52
Q

What happens to aldosterone and renin levels in primary hyperaldosteronism?

A

Raised aldosterone, low renin

53
Q

Once a plasma aldosterone to renin ratio has confirmed primary hyperaldosteronism, what further investigations should be performed to identify the underlying cause?

A

CT abdomen and adrenal vein sampling

54
Q

How is primary hyperaldosteronism caused by Conn’s syndrome treated?

A

Adrenalectomy

55
Q

How is primary hyperaldosteronism caused by adrenocortical hyperplasia treated?

A

Potassium sparing diuretic e.g. spironolactone

56
Q

What causes secondary hyperaldosteronism?

A

High renin levels as a result of low renal blood flow

Gen Med (Endocrine) (12 decks)

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