Adrenal Disease 1

Question 1

What effect does prolonged stress have on cortisol levels? What effect does this have on the body?

Answer 1

. Prolonged stress= prolonged elevated cortisol levels

. Hyperglycaemia, muscle wasting, impaired immune response, increased susceptibility to GI ulcers

Question 2

What is Cushing’s? What are primary, secondary, and ectopic Cushing’s?

Answer 2

. Excess glucocorticoid (cortisol)

. Primary- Adrenal tumour secreting cortisol
. Secondary- Pituitary tumour secreting ACTH (stimulates adrenal gland to release more cortisol)
. Ectopic- Tumour in lungs, pancreas, ovaries secreting excess ACTH (stimulates adrenal gland to release more cortisol)

Question 3

What is Conn’s?

Answer 3

Excess mineralocorticoid (aldosterone)

Question 4

What is Addison’s?

Answer 4

Adrenal insufficiency

Question 5

What are the levels of ACTH and cortisol like with the different types of Cushing’s?

Answer 5

. Primary- low ACTH, high cortisol
. Secondary- high ACTH, high cortisol
. Ectopic- high ACTH, high cortisol

Question 6

What are the tests for Cushing’s?

Answer 6

Serum cortisol, serum ACTH, DEX test, CRH stimulation test

Question 7

What is the DEX test?

Answer 7

. Inject dexamethasone, which should suppress ACTH

. If cortisol levels not suppressed, suggests primary Cushing’s

Question 8

What is the CRH test?

Answer 8

. Inject CRH- should increase ACTH and cortisol

. Secondary to pituitary tumour= exaggerated response
. Secondary to ectopic= no response

Question 9

How is imaging used to help diagnose Cushing’s?

Answer 9

. MRI of pituitary
. Abdominal CT/MRI of adrenal gland
. Chest x-ray of bronchial region
. Octreoscan (type of scintigraphy) for ACTH-secreting tumours

Question 10

What is treatment for Cushing’s?

Answer 10

Surgery, radiotherapy, steroidogenesis-inhibiting drugs

Question 11

What is the difference between Cushing’s syndrome and Cushing’s disease?

Answer 11

Cushing’s syndrome is signs and symptoms caused by having excess cortisol (due to adrenal tumour or medication)
Cushing’s disease is excess cortisol due to a tumour of the anterior pituitary (produces excess ACTH, which stimulates adrenal gland to produce excess cortisol)