Adrenal disease 2

Question 1

What is Conns disease

Answer 1

Mineralocorticoid excess

-Primary hyperaldosteronism

Question 2

What is a common cause of Conn’s

Answer 2

Tumour which produces a large amount of aldosterone

Question 3

What does aldosterone do in kidneys and so what is a sign of Conn’s

Answer 3

Increased sodium absorption and water absorption and potassium loss (hypokalaemia, weakness)

Question 4

What does chronic hypokalaemia lead to

Answer 4

Renal dysfunction which leads to polyuria

Question 5

What is the main clinical finding in Conn’s

Answer 5

Hypertension

Question 6

How to treat Conn’s

Answer 6

Surgery, aldosterone receptor antagonists (spironolactone)

Question 7

What is Addison’s disease

Answer 7

Adrenal insufficiency

Question 8

What is Addison’s disease brought about by

Answer 8

Failure of the adrenal glands - gradual destruction of the adrenal tissue often autoimmune, or by TB or HIV

Question 9

What are the clinical findings of Addison’s

Answer 9

low aldosterone
low cortisol
low androgens
elevated ACTH

Question 10

What are the symptoms of Addison’s

Answer 10

Postural hypotension
Muscle weakness, fatigue, lethargy
HYponatraemia (low sodium), Hyperkalemia
Nausea, vomiting
Weight loss/ anorexia
Increased pigmentation

Question 11

Why is there increased pigmentation in Addison’s disease

Answer 11

ACTH production increased, as is MSH (melanocyte-stimulating hormone) therefore there is increases melanin content in skin

Question 12

Where is hyperpigmentation usually seen in Addison’s disease

Answer 12

Skin creases
Old scars
Gums
Inside of the cheek

Question 13

How would you test for and confirm Addisons

Answer 13

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)

Question 14

What is the treatment for Addisons

Answer 14

Life-long hormone replacement

Glucocorticoid- hydrocortisone
Mineralocorticoid-fludrocortisone

Question 15

When should higher doses of glucocorticoids be given in Addisons disease

Answer 15

During times of illness or major stress e.g. surgery

Question 16

What is secondary adrenal insufficiency and causes

Answer 16

Lack of ACTH production (tumour, damage to pituitary)

Low cortisol with normal aldosterone levels (RAAs intact)

Question 17

What are exogenous causes of secondary adrenal insufficiency

Answer 17

Exogenous glucocorticoid use
-Secondary adrenal suppression

Suppression of ACtH levels leading to suppression and atrophy of adrenal cortex which leads to low endogenous cortisol

Question 18

What can adrenal insufficiency present as

Answer 18

Excess exogenous glucocorticoids can lead to cushingoid appearance (truncal obesity, round faces, striae and dorsocervical pads)

Question 19

What happens when there is sudden, abrupt withdrawal of exogenous steroid

Answer 19

-Symptoms of acute adrenal insufficiency (fatigue, N&V, anorexia, weight loss, hypotension, myalgia)

Because of lack of endogenous cortisol activity

Question 20

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)

Answer 20

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

Question 21

What is Congenital adrenal Hyperplasia

Answer 21

Inherited defect in an enzyme involved in the production of cortisol and aldosterone

Question 22

What is the most common cause of Congenital adrenal Hyperplasia

Answer 22

Deficiency of 21B - hydroxylase

Question 23

What are aldosterone and cortisol levels like in congenital adrenal hyperplasia

Answer 23

Decreased levels of aldosterone and cortisol

Increased androgens and ACTH

Question 24

What is congenital adrenal hyperplasia presented as

Answer 24

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)

Question 25

Treatment of congenital adrenal hyperplasia

Answer 25

HOrmone replacement

plastic surgery

Question 26

What does elevated ACTH lead to

Answer 26

Adrenal hyperplasia

Question 27

Main cause of Addisons

Answer 27

Autoimmune destruction of adrenal cortex