Adrenal Clinical

Question 1

What are some of the androgens that are produced in the adrenal gland?

Answer 1

DHEA (dihydroepisandrosterone)
Androstenedione
Testosterone

Question 2

What are some of the catecholamines that are produced in the adrenal gland?

Answer 2

Adrenaline

Noradrenaline

Question 3

What is the name of the disease given to hypofunction of the adrenal glands?

Answer 3

Addison’s disease

Question 4

What diseases are associated with the hyperfunction of the adrenal glands?

Answer 4

Cushing’s
Pheochromocytoma
Conn’s/hyperaldosteronism

Question 5

What is diffuse hyperpigmentation in mouth/palmar creases/knuckles a sign of?

Answer 5

Primary hypoadrenalism

Question 6

What are some causes of primary hypoadrenalism?

Answer 6

Abrupt discontinuation of steroids
Addison's disease
TB
Surgery
Haemorrage

Question 7

What are the symptoms of primary hypoadrenalism

Answer 7

weight loss
malaise
diarrhoea
nausea/vomiting
syncope/low bp
myalgia

Question 8

What are some of the signs of primary hypoadrenalism

Answer 8

Pigmentation
Postural hypotension
wasting
dehydration
loss of body hair

Question 9

What investigations are important for primary hypoadrenalism

Answer 9

Random cortisol
short synacthen test (synthetic ACTH, measure cortisol before and after ACTH is given)

Measure plasma ACTH
Urea and electrolytes

Adrenal antibodies can confirm if autoimmune, but a negative test still doesn’t rule it out 50% of the time.

Question 10

Describe the Na and K levels in adrenal insufficiency

Answer 10

Hyponatraemia and hyperkalaemia

Question 11

What is the treatment of adrenal failure

Answer 11

ICU Care as it is a medical emergency.
Give fluids and Na
IV hydrocortisone @ high dose

Maintenance treatment:
Glucocorticoids (hydrocortisone and prednisolone)
Mineralocorticoids (fludrocortisone)

Question 12

What are the signs of Cushing’s disease?

Answer 12

Hypertension
Osteoporosis
Kyphosis 
Buffalo hump
Striae
Oedema
Proximal myopathy
Diabetes mellitus

Question 13

What is a dexamethasone suppression test?

Answer 13

Dexamethasone is cortisol so it causes neg feedback to reduce the amount of ACTH released from the anterior pituitary gland.
This test is used to diagnose Cushing’s disease as cortisol levels will stay really high even with a low dose of dexamethasone administered.

Question 14

How can you test to confirm Cushing’s disease

Answer 14

Dexamethasone suppression test

24 urinary cortisol (if the kidney function is normal)

Check mid night cortisol; cortisol levels should be low at night but if they are abnormal it means there is a loss of diurnal rhytmic control of cortisol release

Question 15

What is the treament for Cushing’s disease?

Answer 15

Laparoscopic adrenalectomy

Replacement glucocorticoids (hydrocortisone)

Question 16

What is the presentation of a patient with pheochromocytoma like

Answer 16

Headaches
Palpitations
Sense of doom
chest pain
sweating
weight loss

Question 17

How is pheochromoxytoma diagnosed?

Answer 17

24 hour urine catecholamines

Question 18

How is pheochromocytoma treated

Answer 18

Surgical removal of tumour of adrenal gland + pretreatment with alpha and beta blockade.

Alpha blockade to block effect of catecholamine flooding during surgery, preventing hypotensive collapse.
Beta blockade counteracts tachycardia that comes with the alpha blockade

Question 19

Resistant hypertension with hypokalaemia is a sign of?

Answer 19

Conn’s syndrome/hyperaldosteronism

Question 20

What are the signs of Conn’s syndrome/hyperaldosteronism

Answer 20

Hypertension, hypokalaemia, metabolic alkalosis

Question 21

What is Conn’s syndrome?

Answer 21

Primary hyperaldosteronism

Question 22

How is Conn’s syndrome treated?

Answer 22

Laparoscopic removal of the adenoma

Drug treatment with spironolactone, eplerenone.

Question 23

What is spironolactone?

Answer 23

A potassium sparing diuretic

Question 24

What is eplerenone?

Answer 24

An aldosterone receptor blocker used to treat primary hyperaldosteronism