Adrenal disease Flashcards
The zona fasciculata makes cortisol true or false?
True
What does reticularis make?
…
What is the order of the zones
glomerulosa (outside), fasciculata, reticularis (inside), then medulla…
Case 1: what diagnosis does this TSH (>50) suggest? and FT4 < 5nM
Na 125, K 6.5 …
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
Schmidt’s syndrome
addison’s disease and primary hypothyroidism
What test to confirm addison’s
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
Short synacthen test how to do it
measure cortisol + acth at start of test, administer 250 micrograms synthetic ACTH …
Case 2: 32 year old presents with hypertension, noted to have adrenal mass, three possible differentials
Phaeochromocytoma, (adrenal mudullary tumour secreting adrenaline), Conn’s sydrome (adrenal tumour secreting aldosterone), Cushing’s syndrome (secretes cortisol)
Will TB give hyponatraemic and hypoglycaemic and hyperkalaemic?
Yes
Mass in medulla
Phaeo
Mass in ?
Conn’s
Mass in ?
Cushing’s
What treatment for phaeo urinary catecholamines
alpha 1 blocker?
Why alpha before beta
to prevent reflex tachycardia
what to do phaeo
alpha, then beta then surgery
conns cushings phaeo
aldosterone cortisol adrenaline
Tests for cushings
… dex
causes of cushings syndrome
being on oral steroids for something else, pituitary dependent Cushings disease (85%), ectopic ACTH (5%), adrenal adenoma (10%)
Cushing’s disease vs cushings syndrome
cushing;s disease - definitely pituitary related
Cushing’s symptoms but normal results in obese patient
normal obese patient
why IPSS/pituitary sampling and not MRI for pituitary?
…
