Adrenal disease 2 Flashcards
What is Conns disease
Mineralocorticoid excess
-Primary hyperaldosteronism
What is a common cause of Conn’s
Tumour which produces a large amount of aldosterone
What does aldosterone do in kidneys and so what is a sign of Conn’s
Increased sodium absorption and water absorption and potassium loss (hypokalaemia, weakness)
What does chronic hypokalaemia lead to
Renal dysfunction which leads to polyuria
What is the main clinical finding in Conn’s
Hypertension
How to treat Conn’s
Surgery, aldosterone receptor antagonists (spironolactone)
What is Addison’s disease
Adrenal insufficiency
What is Addison’s disease brought about by
Failure of the adrenal glands - gradual destruction of the adrenal tissue often autoimmune, or by TB or HIV
What are the clinical findings of Addison’s
low aldosterone
low cortisol
low androgens
elevated ACTH
What are the symptoms of Addison’s
Postural hypotension Muscle weakness, fatigue, lethargy HYponatraemia (low sodium), Hyperkalemia Nausea, vomiting Weight loss/ anorexia Increased pigmentation
Why is there increased pigmentation in Addison’s disease
ACTH production increased, as is MSH (melanocyte-stimulating hormone) therefore there is increases melanin content in skin
Where is hyperpigmentation usually seen in Addison’s disease
Skin creases
Old scars
Gums
Inside of the cheek
How would you test for and confirm Addisons
Test for adrenal failure
- Decreased cortisol and increased ACTH
- ACTH stimulation test (stimulation test for adrenal function). If you give ACTH, should expect an increase in cortisol. But if not, may mean Addisons
- Adrenal autoantibodies (if you suspect autoimmune disease)
What is the treatment for Addisons
Life-long hormone replacement
Glucocorticoid- hydrocortisone
Mineralocorticoid-fludrocortisone
When should higher doses of glucocorticoids be given in Addisons disease
During times of illness or major stress e.g. surgery
What is secondary adrenal insufficiency and causes
Lack of ACTH production (tumour, damage to pituitary)
Low cortisol with normal aldosterone levels (RAAs intact)
What are exogenous causes of secondary adrenal insufficiency
Exogenous glucocorticoid use
-Secondary adrenal suppression
Suppression of ACtH levels leading to suppression and atrophy of adrenal cortex which leads to low endogenous cortisol
What can adrenal insufficiency present as
Excess exogenous glucocorticoids can lead to cushingoid appearance (truncal obesity, round faces, striae and dorsocervical pads)
What happens when there is sudden, abrupt withdrawal of exogenous steroid
-Symptoms of acute adrenal insufficiency (fatigue, N&V, anorexia, weight loss, hypotension, myalgia)
Because of lack of endogenous cortisol activity
What should the treatment be when the patient has suddenly come off their steroid medication and they are under stress (and what are the possible consequences)
It is a medical emergency when there is acute adrenal insufficiency and expressed when patient is under stress e.g. infection
Can lead to hypotension, circulatory failure, potentially death
URGENTTreatment:
- I.v. fluids, hydrocortisone
- Then when stable, give oral hydrocortisone
What is Congenital adrenal Hyperplasia
Inherited defect in an enzyme involved in the production of cortisol and aldosterone
What is the most common cause of Congenital adrenal Hyperplasia
Deficiency of 21B - hydroxylase
What are aldosterone and cortisol levels like in congenital adrenal hyperplasia
Decreased levels of aldosterone and cortisol
Increased androgens and ACTH
What is congenital adrenal hyperplasia presented as
In severe cases: female may be born with ambiguous genitalia resulting in incorrect gender assignment
In less severe
children: early onset puberty
females: virilization (muscular growth, facial hair)
Treatment of congenital adrenal hyperplasia
HOrmone replacement
plastic surgery
What does elevated ACTH lead to
Adrenal hyperplasia
Main cause of Addisons
Autoimmune destruction of adrenal cortex
