Adrenal disease 290921 Flashcards
• 31yo, profound fatigue, acutely unwell for a few days, vomiting
• Test results:
o Na = 125 K = 6.5 U = 10 Glucose = 2.9mM
o FT4 = <5nM TSH = >50mU/L
• TSH and T4 measurements Primary hypothyroidism (or thyroid failure)
- Unusual U&Es (hyponatraemia and hyperkalaemia) mineralocorticoid deficiency Addison’s disease
- Hypoglycaemia glucocorticoid deficiency
addisons + primary hypothyroidism = schmidt’s syndrome
what is schmidt’s syndrome
o AKA: Polyglandular autoimmune syndrome type II
o Antibodies against the thyroid and adrenal glands
how to measure addisons
o 1) Measure cortisol and ACTH at start
o 2) 250ug ACTH, IM
o 3) Check cortisol at 30 and 60 minutes
TB patients addisons
TB invades adrenals
management addisons
o Management = IV 0.9% saline (1L/hour), IV hydrocortisone
Test for Phaeochromocytoma
urinary catecholamines
Emergency treatment for phaeo
alpha blockade, phenoxybenzamine, then beta blockers, then surgery (very careful surgery as if you touch it the alpha receptors could be stimulated)
32 yo HTN, adrenal mass
conn’s, cushings, phaeo
Genetic links of phaeo
MEN2, Von hippel Lindau syndrome, neurofibromatosis type 1
• 33yo, HTN
• Urea and electrolytes:
o Na = 147 K = 2.8 U = 4.0 Glucose = 4.0mM
o Plasma aldosterone raised Plasma renin suppressed
• Primary hyperaldosteronism / Conn’s Syndrome
o Adrenal gland autonomously secretes aldosterone HTN supress renin production at JGA
• 34yo, obese woman, T2DM, HTN, bruising
• Urea and electrolytes:
o Na = 146 K = 2.9 U = 4.0 Glucose = 14.0mM
o Aldosterone = <75 (low) Renin = low
cushing’s
Cushing’s diagnosis test
DEX suppression test
Commonest cause of cushings syndrome
oral steroids
if NOT on drugs 85% cause is pituitary dependent cushing’s disease
5% ectopic ACTH
10% adrenal adenoma
psuedoCushing’s
obesity can change metabolism of cortisol condition mimicking Cushing’s (pseudo-Cushing’s syndrome)
How is the cause of cushings confirmed
Pituitary SAMPLING
A catheter is fed into the jugular vein
Distinguishes pituitary dependant from ectopic ACTH