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Week 9 - Phase 3 > Adrenal Disease > Flashcards

Adrenal Disease Flashcards

1
Q

Describe the cortex of the adrenal gland?

A
  • Glomerulosa: Makes mineralocorticoids e.g. aldosterone.
  • Fasiculata: Makes glucocorticoid e.g. cortisol.
  • Reticularis: Makes androgens e.g. DHEA
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2
Q

Describe the medulla of the adrenal gland?

A

Produces catecholamines e.g. adrenaline (80%) and noradrenaline (20%).

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3
Q

What is the function of aldosterone?

A

Causes Na+ retention and K+ secretion via ENac and Na/K+ ATPase.

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4
Q

What regulates aldosterone production?

A

The RAAS

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5
Q

How is cortisol production regulated?

A

Hypothalamus produces corticotropin releasing hormone (CRH)
Anterior pituitary releases Adrenocorticotropic hormone (ACTH)
Adrenal cortex produces Cortisol.

Cortisol has negative feedback to both the hypothalamus and pituitary.

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6
Q

What would these blood results indicate?
High aldosterone
Low Renin
High ARR

A

Primary aldosteronism

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7
Q

What should the normal aldosterone-renin-ratio be?

A

<35

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8
Q

What medications should be stopped in primary aldosteronism?

A
  • B blockers and MR antagonists
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9
Q

What investigations would you do to confirm primary aldosteronism?

A

A Saline Suppression Test

  • Give 2L of saline over 4h
  • 4h aldosterone >270 is

CT imaging to look for an adrenal adenoma.

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10
Q

How is primary aldosteronism managed?

A

Surgically

  • Laproscopic adrenalectomy of an adrenal adenoma.
  • Cures hypokalemia and hypertension

Medical

  • Use MR antagonists
  • e.g. Spironolocatone
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11
Q

What are some clinical features of Cushing’s syndrome?

A 
Buffalo hump 
Striae 
Central obesity 
Proximal myopathy 
Poor would healing/easy bruising 
Thin skin 
Hypertension 
Moon face with plethoric cheeks.
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12
Q

What causes cushings syndrome?

A

Elevated cortisol

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13
Q

How do we test for elevated cortisol?

A

Perform 2 of …

  • 24h Urinary free cortisol
  • Urine cortisol:creatinine ratio x3
  • Dexamethasone suppression test: Give high steroid at night and in the morning should be undetectable.
  • Late night salivary cortisol: Should be low at night as cortisol has diurnal variation.
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14
Q

List causes of ACTH dependent cushings syndrome?

A

Pituitary adenoma (cushings disease)
Ectopic ACTH
Ectopic CRH

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15
Q

List causes of ACTH independent cushings syndrome?

A

Adrenal adenoma
Adrenal carcinoma
Nodular hyperplasia

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16
Q

How is congenital adrenal hyperplasia inherited?

A

Autosomal recessive disorder

17
Q

What gene is most commonly affected in congenital adrenal hyperplasia?

A

CYP21 coding for 21-alpha hydroxylase

18
Q

What are the clinical features of CDH in females?

A

Ambiguous genitalia

19
Q

What are the clinical features of CAH in males?

A
  • Adrenal crisis (hypotension, hyponatraemia)

- Early virilisation

20
Q

How is CAH treated?

A

Mineralocorticoid and glucocorticoid replacement

21
Q

What is pheochromocytoma?

A

Increased catecholamines due to a tumor of adrenal medulla or due to extra-adrenal tumors secreting catecholamine e.g. sympathetic ganglia.

22
Q

What are the signs and symptoms of phaeochromocytoma?

A
  • Hypertension
  • headache
  • palpitations
  • pallor
  • sweating
  • tremor
  • anxiety
  • nausea, vomiting
  • chest or abdo pain
  • Normally have crisis of 15 minutes but in between feel well otherwise.
23
Q

What genetic conditions are associated with pheochromocytoma?

A

MEN

Neurofibromastosis

24
Q

Are most phaechromocytomas malignant or benign?

A

Benign

25
Q

What imaging test are used to see adrenal glands?

A

CT ot MRI

26
Q

Give examples of primary adrenal insufficiency?

A

Addisons disease

Autoimmune destruction

27
Q

What are the clinical features of adrenal insufficiency?

A
  • weight loss
  • fatigue
  • dizzy and low BP
  • abdo pain, vomiting, diarrheoa
  • skin pigmentation
28
Q

How is adrenal insufficiency diagnosed?

A
  • Biochemistry: Low sodium, high potassium, hypoglycemia
  • Short synACTHen test: measure plasma cortisol before, and 30 mins after an IV ACTH injection. Normally >250 baseline and >480 post ACTH.
  • High renin, low aldosterone
  • May have adrenal autoantibodies.
29
Q

What causes skin pigmentation in Addison’s disease?

A

High ACTH

30
Q

What imaging should be used for the pituitary gland?

A

MRI

Week 9 - Phase 3 (8 decks)

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