Adrenal Cases Flashcards
Where is cortisol made?
Zona fasciculata
31 yo presents with fatigue and vomiting, acutely unwell for few days
Na: 125, K: 6.5, U 10, Glucose 2.9mM.
FT4 < 5nM TSH > 50mU/l
What does this TSH suggest?
Primary Hypothyroidism
Na: 125, K: 6.5, U 10, Glucose 2.9mM.
FT4 < 5nM TSH > 50mU/l
Other than the thyroid disease, what other abnormalities are seen here?
Hyponatraemia
Hyperkalaemia
Hypoglycaemia
Na: 125, K: 6.5, U 10, Glucose 2.9mM.
FT4 < 5nM TSH > 50mU/l
What are these electrolyte abnormalities suggestive of (aside from the TSH)?
Hyponatraemia, hyperkalaemia
Deficiency of mineralocorticoid.
Hypoglycaemia
Deficiency of glucocorticoid.
Which endocrine disease typically presents with hyponatraemia, hyperkalaemia and hypoglycaemia?
Addisons disease
What is Schmidt’s syndrome (polyglandular autoimmune syndrome type II)?
Addison’s disease and primary hypothyroidism occur together more commonly than by chance alone.
What is the test for Addisons?
Short Synacthen test
How do you carry out the short synacthen test?
Measure cortisol + ACTH at start of test
Administer 250 micrograms synthetic ACTH by IM injection.
Check cortisol at 30 and 60 minutes.
A patient’s short synacthen test results show this:
ACTH > 100 ng/dl
Cortisol < 10 nM
Check cortisol at 30 and 60 minutes.
Both times, cortisol < 10 nM
What is the diagnosis?
Addisons disease
A 32 year old presents with hypertension.
He is noted to have an adrenal mass.
There are three possible differentials:
What is the differential diagnosis ?
Phaeochromocytomas
Conn’s syndrome
Cushing’s syndrome
Further investigations reveal that he has high levels of urinary catecholamines.
What urgent drug treatment is required?
What is the cure?
Urgent alpha blockade with phenoxybenzamine.
Add beta blockade.
Finally arrange surgery.
What is a phaeochromocytoma?
Adrenal medullary tumour that secretes adrenaline, and can cause severe hypertension, arrhythmias and death.
Hypertensive 33 year old.
Na 147, K 2.8, U 4.0. Glucose 4.0 mM
Plasma aldosterone raised.
Plasma renin suppressed.
What is the diagnosis ?
Conn’s syndrome
34 year old obese woman with type 2 diabetes, presents with hypertension and bruising.
Na: 146, K: 2.9, U 4.0, Glucose 14.0
Aldosterone <75 (low). Renin low
What is the diagnosis?
Cushing’s Syndrome
What is the test for Cushing’s?
9am cortisol
12 midnight cortisol
