Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

YR5 Chemical Pathology > Adrenal disease > Flashcards

Adrenal disease Flashcards

1
Q

Recall the 3 zones of the adrenal gland and what is produced in each one

A

Zone glomerulosa = aldosterone
Zona fasiculata = cortisol
Zona reticularis = androgens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the peripheral and adrenal catecholamines?

A

Peripheral: Noradrenaline
Adrenal: Adrenaline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Give 2 likely causes of wasted adrenal glands

A

Addison’s disease
Long term steroid tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Give 2 likely causes of hyper plastic adrenal glands

A

Cushing’s disease
Ectopic ACTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do the measurements of aldosterone and cortisol differ?

A

A: PICOmoles
C: NANOmoles (you make 1000x more C than A)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What diagnosis would you suspect in a patient with fatigue and high TSH and low T4?

A

Primary hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is Schmidt’s syndrome?

A

Primary hypothyroisidm + Addisson’s disease
Antibodies against thyroid + adrenals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What’s the test for Addison’s, and how should it be performed?

A

SynACTHen test
1. Measure cortisol + ACTH
2. 250ug ACTH IM
3. Check cortisol at 30 + 60m
If fail to stimulate = failure of endocrine function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the expected electrolyte abnormality in untreated primary adrenal failure?

A

Hyponatraemia
Hyperkalaemia
(Mineralocorticoid deficiency)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What abnormalities may accompany hyponatraemia and hyperkalaemia in Addisons disease?

A

Hypoglycaemia (glucocorticoid deficiency)
Low BP (mineralocorticoid deficiency)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the treatment for a patient in an addisonian crisis?

A

IV Saline 0.9% 1L/hr
IV Hydrocortisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the long term treatment for Addisons disease?

A

Hydrocortisone (Glucocorticoid)
Fludrocortisone (Mineralocorticoid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the 3 differentials to consider when a patient with severe HTN also has an adrenal mass?

A
  1. Phaeochromocytoma (medullary tumour secreting adrenalinę)
  2. Conn’s syndrome (zona glomerulosa tumour: secreting aldosterone)
  3. Cushing’s (zona fasciculata tumour secreting cortisol)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What test is used to identify pheochromocytoma?

A

Urinary catecholamines: HIGH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How should phaeochromocytoma be treated?

A
  1. IMMEDIATE: Alpha blockers (phenoxybenzamine) causes reflex tachy
  2. Beta blockers (to deal with reflex tachycardia)
  3. Surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the expected aldosterone and renin levels in untreated Conn’s syndrome?

A

HIGH Aldosterone
LOW Renin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What electrolyte abnormalities would you see in Conn’s syndrome?

A

HIGH Na
LOW K+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe why Renin is suppressed in Conn’s

A

Adrenal gland autonomously secretes aldosterone
Causes increased Na + water retention + K+ excretion
HTN
Suppresses renin production at JGA

19
Q

How does treatment differ if Conn’s syndrome is caused by unilateral adrenal adenoma or bilateral adrenocortical hyperplasia?

A

Unilateral: Surgery
Bilateral: Spironolactone (aldosterone antagonist)

20
Q

What are the expected aldosterone and renin levels in untreated Cushing’s syndrome?

A

LOW Aldosterone
LOW Renin

21
Q

What biochemical abnormalities would you see in Cushing’s syndrome?

A

HIGH Na
LOW K
HIGH Glucose

22
Q

What 3 tests can be used to investigate for Cushing’s?

A
  1. 9am cortisol (HIGH in ALL)
  2. Sneaky midnight cortisol (HIGH in CUSHING’s)
  3. Dexamethosone suppression test (NO ACTH suppression)
23
Q

What does the term ‘cushing’s disease’ refer to?

A

Cushing’s syndrome caused by a pituitary tumour secreting ACTH
DISEASE = pituitary DEPENDENT

24
Q

What is the diagnosis in a patient with symptoms of Cushing’s but a normal result in the low-dose dexamethosone suppression test?

A

Normal obese person

25
Q

What is the diagnosis in a patient with symptoms of Cushing’s but only a very slightly suppressed cortisol in the low-dose dexamethosone suppression test?

A

Cushing’s syndrome of indeterminate cause

26
Q

How should Cushing’s syndrome of indeterminate cause be investigated to determine whether pituitary dependent or ectopic?

A

Inferior petrosal sinus sampling with CRH stimulation
Catheter fed into jugular veins.
If ACTH high centrally = Cushing’s disease.

27
Q

Give 3 conditions associated with MEN2a

A

Parathyroid tumour
Medullary thyroid cancer
Phaeochromocytoma

28
Q

Give 3 conditions associated with von Hippel Lindau syndrome

A

Phaeochromocytoma
Renal cell carcinoma
Renal cysts
Haemangioblastoma

29
Q

Give 3 features of Neurofibromatosis type 1

A

Phaeochromocytoma
Peripheral/ spinal neurofibromas
Cafe au lait spots

30
Q

Describe the low dose dexamethasone suppression test

A
  1. At 11pm give 1mg dexamethasone
  2. Measure cortisol before 9am
31
Q

Why is a high dose dexamethasone suppression test rarely used to confirm the cause of Cushing’s syndrome?

A

85% are pituitary dependent without the test and test has 20% false positives (same with MRI)

32
Q

How does Cushing’s cause hypertension?

A

At high conc. Cortisol activates the MR
Increases Na + water reabsorption
11b hydroxysteroid dehydrogenase usually degrades cortisol to stop this, but is overwhelmed at this conc.

33
Q

What is the treatment for Cushing’s disease? What is the treatment for Cushing’s syndrome caused by adrenal adenoma?

A

CD: Transsphenoidal Hypophysectomy
CS: Bilateral adrenalectomy

34
Q

4 causes of Cushing’s syndrome

A

Oral steroids
Pituitary dependent Cushing’s disease
Ectopic ACTH in SCLC
Adrenal adenoma secreting cortisol

35
Q

State the drugs that are used to treat Cushing’s syndrome before and surgery.

A

Before: Metyrapone (inhibits cortisol production) + Mifepristone
After: Hydrocortisone + hormone replacement

36
Q

State 3 causes of adrenocortical failure.

A

TB Addison’s Disesae (commonest worldwide)
AI Addison’s Disease (commonest in UK)
Congenital Adrenal Hyperplasia

37
Q

What is the most common cause of congenital adrenal hyperplasia (CAH)?

A

21-hydroxylase deficiency

38
Q

Why are foetuses with CAH normally fine in utero?

A

In utero, the foetus’ will have maternal cortisol + aldosterone so don’t need to rely on their own endogenous production.

39
Q

What will happen to a baby with complete 21-hydroxylase deficiency after they are born?

A

They will have a salt losing Addisonian crisis due to the lack of aldosterone.
Survive <24 hours if untreated

40
Q

What are the 2 main features of 21-hydroxylase deficiency?

A

Hypotension
Virilisation (female babies will be born with ambiguous genitalia)

41
Q

List 4 features of partial 21-hydroxylase deficiency

A

Male pattern balding
Hirsutism
Irregular menstruation
Clitoral enlargement

42
Q

Describe the presentation of partial 21-hydroxylase deficiency.

A

Present later because they don’t have a salt losing Addisonian crisis.
Present once they start to see the effects of the excess adrenal sex steroids e.g. hirsuitism + precocious puberty
Also slightly hypotensive

43
Q

What would the adrenal glands look like in autoimmune Addisons, TB and metastasis?

A

AI: Atrophied adrenals, very small
TB: Granulomatous infiltration
Metastasis: Large tumour

44
Q

Why do babies with congenital adrenal hyperplasia have enlarged adrenals?

A

ACTH is raised to drive the adrenal cortex to produce its steroids, but only sex steroids can be produced
Excess ACTH makes adrenals grow

YR5 Chemical Pathology (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions