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Y2 Endocrine > Adrenal Disease > Flashcards

Adrenal Disease Flashcards

1
Q

what does the adrenal medulla secrete?

A

catecholamines

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2
Q

name two catecholamines

A

noradrenaline

adrenaline

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3
Q

name two adrenal androgens

A

DHEA

androstenedione

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4
Q

what is the starting point for steroid hormones produced by the adrenal glands?

A

cholesterol

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5
Q

what regulates production of aldosterone?

A

RAAS

plasma potassium

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6
Q

what are the three main clinical uses for corticosteroids?

A

suppress inflammation
suppress the immune system
replacement treatment

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7
Q

what are the three routes of administration of corticosteroids?

A

oral
IM
IV

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8
Q

what is adrenal insufficiency?

A

when there is inadequate adrenocortical function

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9
Q

what are the two types of adrenal insufficiency?

A

primary

secondary

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10
Q

what causes primary adrenal insufficiency?

A

disorders of the adrenal gland

addison’s. CAH, adrenal TB/malignancy

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11
Q

what causes secondary adrenal insufficiency?

A

lack of ACTH production

steroids, pituitary disease, hypothalamic disease

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12
Q

what is addison’s disease?

A

autoimmune destruction of the adrenal cortex

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13
Q

how does addison’s present? (5)

A 
anorexia
fatigue 
dizziness 
abdominal pain 
skin pigmentation
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14
Q

what is the most common cause of primary adrenal insufficiency?

A

addison’s disease

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15
Q

what biochemistry should raise suspicion of adrenal insufficiency?

A

low sodium
high potassium
hypoglycaemia

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16
Q

what is the diagnostic test for adrenal insufficiency?

A

short synacthen test

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17
Q

what does a short synacthen test involve?

A

measure plasma cortisol before and then 30 mins after an ACTH injection

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18
Q

what is a normal result from a short synacthen test?

A

baseline >250

post ACTH >550

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19
Q

what are ACTH levels like in addison’s disease?

A

raised

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20
Q

what causes the skin pigmentation in addison’s disease?

A

raised ACTH

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21
Q

what are renin and aldosterone levels like in addison’s disease?

A

increased renin

reduced aldosterone

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22
Q

what is the management of primary adrenal insufficiency?

A

hydrocortisone

fludrocortisone

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23
Q

what is cushing’s syndrome?

A

excess cortisol secretion

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24
Q

what group is cushing’s syndrome more common in ?

A

women aged 20-40

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25
Q

name five clinical features of cushing’s syndrome

A 
bruising 
striae 
obesity 
thin skin 
proximal myopathy
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26
Q

what are the three categories of causes of cushing’s syndrome?

A

ACTH dependent
ACTH independent
iatrogenic

27
Q

name two ACTH dependent causes of cushing’s syndrome

A

cushing’s disease

ectopic ACTH/CRH

28
Q

what is cushing’s disease?

A

a pituitary adenoma secreting excess ACTH

29
Q

what is the gold standard test for cushing’s syndrome?

A

low dose dexamethasone suppression test

30
Q

what happens in a low dose dexamethasone suppression test?

A

patient takes 0.5mg of dexamethasone every 6 hours for 48 hours

31
Q

what is a normal result for a low dose dexamethasone suppression test?

A

cortisol suppressed to less than 50 at the end of the test

32
Q

what is the most common cause of cushing’s syndrome?

A

iatrogenic - due to prolonged steroid therapy

33
Q

what is primary aldosteronism?

A

autonomous production of aldosterone

34
Q

what is the most common cause of secondary hypertension?

A

primary aldosteronism

35
Q

what are the three main clinical features of primary aldosteronism?

A

hypertension
hypokalaemia
alkalosis

36
Q

what are the two main causes of primary aldosteronism?

A

adrenal adenoma

bilateral adrenal hyperplasia

37
Q

what is an adrenal adenoma causing primary aldosteronism called?

A

conn’s syndrome

38
Q

how is primary aldosteronism diagnosed?

A

confirm aldosterone excess

confirm cause

39
Q

how is aldosterone excess confirmed in primary aldosteronism?

A

measure the aldosterone:renin

saline suppression test = failure to suppress by >50% = PA

40
Q

how is conn’s syndrome cured?

A

surgical removal

41
Q

how is bilateral adrenal hyperplasia causing primary aldosteronism treated?

A

mineralocorticoid antagonists (spironolactone or eplerenone)

42
Q

what causes congenital adrenal hyperplasia?

A

deficiency in an enzyme needed for cortisol synthesis

43
Q

what is the most common cause of congenital adrenal hyperplasia?

A

21a-hydroxylase deficiency

44
Q

how is congenital adrenal hyperplasia inherited?

A

autosomal recessive pattern

45
Q

what does a 21a-hydroxylase deficiency result in?

A

blocks production of cortisol and aldosterone

increased androgens

46
Q

what are the two types of congenital adrenal hyperplasia?

A

classic

non classic

47
Q

when does classic congenital adrenal hyperplasia present?

48
Q

how can classic congenital adrenal hyperplasia present?

A

adrenal crisis or adrenal insufficiency

virilization

49
Q

what causes non classic congenital adrenal hyperplasia?

A

partial 21a-hydroxylase deficiency

50
Q

when does non classic congenital adrenal hyperplasia present?

A

adolescence/adulthood

51
Q

how does non classic congenital adrenal hyperplasia?

A

hirsutism
menstrual issues
infertility

52
Q

how is congenital adrenal hyperplasia diagnosed?

A

measure 17-OH progesterone

53
Q

how is congenital adrenal hyperplasia managed?

A

steroid replacement

54
Q

what are catecholamines derived from?

55
Q

where are catecholamines secreted?

A

adrenal medulla

56
Q

how does pheochromocytoma present?

A

hypertension
postural hypotension
paroxysmal sweating, headache, pallor and tachycardia
can be asymptomatic

57
Q

what is a pheochromocytoma called if it is extra adrenal?

A

paraganglionoma

these are found in the sympathetic chain

58
Q

how can pheochromocytoma be fatal?

A

arrythmia

ischaemia

59
Q

how is pheochromocytoma diagnosed?

A

urine or plasma catecholamine measurement

MRI

60
Q

what is done prior to surgery for pheochromocytoma?

A

alpha blockade followed by beta blockade

61
Q

what alpha blocker is given prior to pheochromocytoma surgery?

A

phenoxybenzamine

62
Q

what beta blocker is given prior to pheochromocytoma surgery?

A

propranalol, atenolol or metoprolol

63
Q

what is the treatment of choice for pheochromocytoma?

A

laparoscopic surgical excision

Y2 Endocrine (33 decks)

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