Adrenal condensed Flashcards
Where are mineralocortiocoid receptors?
Kidneys, gut and glands (sweat and salivary)
Dark skin Dehydrated Hypotensive Na K Weight loss Amenorrhea
Decreased Na+
Increased K+
(addisons)
Causes of adrenal insufficiency (primary and secondary)
Primary insufficiency Addison’s disease Congenital Adrenal Hyperplasia (CAH) Adrenal TB/malignancy Secondary insufficiency Due to lack of ACTH stimulation Iatrogenic (excess exogenous steroid) Pituitary/hypothalamic disorders
Autoimmune diseases associated with Addisons
Type 1 DM, autoimmune thyroid disease, pernicious anaemia
Diagnosis of adrenal insufficiency
‘Suspicious biochemistry’ low Na, high K hypoglycaemia SHORT SYNACTHEN TEST Measure plasma cortisol before and 30 minutes after iv ACTH injection Normal: baseline >250nmol/L, post ACTH >480 ACTH levels Should be (causes skin pigmentation) Renin/aldosterone levels renin aldosterone Adrenal autoantibodies
Prolactinoma symptoms
Infertility
Lack of libido
Amenorrhea
Tumour derived from the remnants of Rathke’s pouch?
Craniopharyngioma
headache, visual disturbances, hypopituitarism
What do neuroendocrine cells secrete?
Catecholamines
Features suggesting adrenocortical carcinoma?
Large size (>50g, often >20cm) Haemorrhage and necrosis Frequent mitoses, atypical mitoses Lack of clear cells Capsular or vascular invasion
In phaeochromoctyoma, what might cause a paroxysmal episode of hypertension?
- Stress
- Exercise
- Posture
- Palpation of tumour (e.g. feeling the tummy can cause release of adrenaline)
Sipple syndrome
MEN2A
Phaeochromocytoma (40-50%), Medullary thyroid carcinoma (100%), parathyroid hyperplasia (10-20%)
Phaeochromocytoma may be bilateral and occur at extra-adrenal sites
Linked to germline gain of function mutation in RET oncogene on chromosome 10q11.2 (ie constitutively activated)
MEN2A (Sipple syndrome)
