Adrenal disease 290921 Flashcards

1
Q

• 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

A

• 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

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2
Q

what is schmidt’s syndrome

A

o AKA: Polyglandular autoimmune syndrome type II

o Antibodies against the thyroid and adrenal glands

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3
Q

how to measure addisons

A

o 1) Measure cortisol and ACTH at start
o 2) 250ug ACTH, IM
o 3) Check cortisol at 30 and 60 minutes

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4
Q

TB patients addisons

A

TB invades adrenals

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5
Q

management addisons

A

o Management = IV 0.9% saline (1L/hour), IV hydrocortisone

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6
Q

Test for Phaeochromocytoma

A

urinary catecholamines

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7
Q

Emergency treatment for phaeo

A

alpha blockade, phenoxybenzamine, then beta blockers, then surgery (very careful surgery as if you touch it the alpha receptors could be stimulated)

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8
Q

32 yo HTN, adrenal mass

A

conn’s, cushings, phaeo

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9
Q

Genetic links of phaeo

A

MEN2, Von hippel Lindau syndrome, neurofibromatosis type 1

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10
Q

• 33yo, HTN
• Urea and electrolytes:
o Na = 147 K = 2.8 U = 4.0 Glucose = 4.0mM
o Plasma aldosterone raised Plasma renin suppressed

A

• Primary hyperaldosteronism / Conn’s Syndrome

o Adrenal gland autonomously secretes aldosterone  HTN  supress renin production at JGA

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11
Q

• 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

A

cushing’s

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12
Q

Cushing’s diagnosis test

A

DEX suppression test

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13
Q

Commonest cause of cushings syndrome

A

oral steroids
if NOT on drugs 85% cause is pituitary dependent cushing’s disease
5% ectopic ACTH
10% adrenal adenoma

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14
Q

psuedoCushing’s

A

obesity can change metabolism of cortisol  condition mimicking Cushing’s (pseudo-Cushing’s syndrome)

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15
Q

How is the cause of cushings confirmed

A

Pituitary SAMPLING
A catheter is fed into the jugular vein
 Distinguishes pituitary dependant from ectopic ACTH

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16
Q

Why don’t we do high dose dex suppression test anymore

A

o We don’t do the high-dose test anymore because 85% are pituitary-dependant without the test and so doing a high-dose test is less accurate (false +ve = 20%) than guessing and so it is not useful
 Equally, pituitary MRIs with gadolinium enhancement is not that useful but can be definitive