Adrenal disease

Question 1

The zona fasciculata makes cortisol true or false?

Answer 1

True

Question 2

What does reticularis make?

Answer 2

…

Question 3

What is the order of the zones

Answer 3

glomerulosa (outside), fasciculata, reticularis (inside), then medulla…

Question 4

Case 1: what diagnosis does this TSH (>50) suggest? and FT4 < 5nM

Na 125, K 6.5 …

Answer 4

Primary hypothyroidism - gives the highest TSH … but low T3/T4 levels.

Suggests thyroid failure but the hypothyroid does not explain the unusual electrolytes

Addison’s disease and primary hypothyroidism -> SCHMIDT SYNDROME

Question 5

Schmidt’s syndrome

Answer 5

addison’s disease and primary hypothyroidism

Question 6

What test to confirm addison’s

Answer 6

Right answer: Short synacthen test

Low dose dex - cushing’s
High dose dex - not used anymore
Glucose tolerance test - DM (2 samples), acromegaly (5 samples)
TRH simulation test

Question 7

Short synacthen test how to do it

Answer 7

measure cortisol + acth at start of test, administer 250 micrograms synthetic ACTH …

Question 8

Case 2: 32 year old presents with hypertension, noted to have adrenal mass, three possible differentials

Answer 8

Phaeochromocytoma, (adrenal mudullary tumour secreting adrenaline), Conn’s sydrome (adrenal tumour secreting aldosterone), Cushing’s syndrome (secretes cortisol)

Question 9

Will TB give hyponatraemic and hypoglycaemic and hyperkalaemic?

Answer 9

Yes

Question 10

Mass in medulla

Answer 10

Phaeo

Question 11

Mass in ?

Answer 11

Conn’s

Question 12

Mass in ?

Answer 12

Cushing’s

Question 13

What treatment for phaeo urinary catecholamines

Answer 13

alpha 1 blocker?

Question 14

Why alpha before beta

Answer 14

to prevent reflex tachycardia

Question 15

what to do phaeo

Answer 15

alpha, then beta then surgery

Question 16

conns cushings phaeo

Answer 16

aldosterone cortisol adrenaline

Question 17

Tests for cushings

Answer 17

… dex

Question 18

causes of cushings syndrome

Answer 18

being on oral steroids for something else, pituitary dependent Cushings disease (85%), ectopic ACTH (5%), adrenal adenoma (10%)

Question 19

Cushing’s disease vs cushings syndrome

Answer 19

cushing;s disease - definitely pituitary related

Question 20

Cushing’s symptoms but normal results in obese patient

Answer 20

normal obese patient

Question 21

why IPSS/pituitary sampling and not MRI for pituitary?

Answer 21

…