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Year 2 MBChB Endocrine > Adrenal Disease > Flashcards

Adrenal Disease Flashcards

1
Q

Name 2 causes of primary hyperaldosteronism and what is hyperalodsteronism the main cause of?

A

Bilateral adrenal hyperplasia
Conn’s syndrome
Secondary hypertension

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2
Q

What is BP, Ca and K levels in primary hyperaldosteronism?

A

High BP
Low Ca
Low K

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3
Q

Explain the screening tests for primary hyperaldosteronism + positive result?

A

A:R ration
If raised do 2L saline suppression
Diagnosed if fail to suppress by 50%

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4
Q

Name 2 diagnostic tests for primary hyperaldosteronism.

A

Adrenal CT

Adrenal vein sampling

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5
Q

What is the treatment for Conn’s + bilateral hyperplasia primary hyperaldosteronism?

A

Conn’s = adrenalectomy

Bilateral hyperplasia = spironolactone

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6
Q

What is Conn’s syndrome and what is it usually caused by?

A

Primary hyperaldosteronism

Adrenocorticol adenoma

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7
Q

What is congenital adrenocorticol hyperplasia caused by + effect + inheritance?

A

Lack of 21 alpha hydroxylase
Can’t synthesise steroids
AR

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8
Q

Name 2 causes of acquired adrenocorticol hyperplasia?

A

Cushing’s syndrome

Paraneoplastic syndrome

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9
Q

Name 3 effects of steroid deficiency in adrenocorticol hyperplasia.

A

High androgens
High ACTH
Low cortisol
Low aldosterone

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10
Q

Name 4 signs of adrenocorticol hyperplasia.

A

Salt-wasting
Malnourishment
Scrotum hyperpigmentation
Female genital amiguity

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11
Q

Test for adrenocorticol hyperplasia?

A

Stimulated progesterone

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12
Q

What is hypercortisolism caused by + 2 types with an example?

A

Cushing’s
Exogenous = steroids
Endogenous = ACTH

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13
Q

Treatment for adrenocorticol hyperplasia?

A

Steroid replacement
Androgen reduction
Surgery

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15
Q

What are the 2 types of acquired adrenocorticol hyperplasia + role of ACTH?

A 
Diffuse = ACTH driven
Nodular = ACTH independent
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16
Q

What is the only definite diagnostic criteria for a malignant adrenocorticol tumour?

A

Metastasis

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17
Q

Name 4 red flag signs for an adrenocorticol mass.

A

> 50g
Haemorrhage
Necrosis
Capsular/vascular invasion

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18
Q

What are the 2 main adrenal medullary tumours?

A

Neuroblastoma

Phaeochromocytoma

19
Q

Name 4 causes of primary adrenal insufficiency starting with the commonest.

A

Addison’s disease
Congenital adrenal hyperplasia
Tumours
Adrenal TB

20
Q

Name 2 causes of secondary adrenal insufficiency?

A

Hypothalamic/pituitary tumours

Exogenous steroids

21
Q

What does a adrenocorticol adenoma look like and is it functional/non-functional + mutation?

A 
Small
Yellow
Even borders
Non-functional
KCNJ5
21
Q

What are the features of an andrenocorticol carcinoma?

A

Functional
Metastasis
Capsular/vascular invasion

23
Q

What is Addison’s disease + key antibody and what % its present in?

A

Autoimmune adrenaocorticol insufficiency

Anti-21-hydroxylase (70%)

24
Q

What percentage of the adrenal glands are destroyed before Addison’s symptoms start?

A

> 90%

25
Q

Name 6 signs of Addison’s disease?

A 
Hyperpigmentation
Dizziness
Hypotension
Weight loss
GI upset
Weakness
26
Q

Name 3 causes of an Addisonian crisis.

A

Infection
Stress
Surgery

27
Q

What is the Na and K levels in Addison’s disease?

A

Low Na

High K

28
Q

Name 3 signs of an Addisonian crisis.

A

N and V
Abdominal pain
Shock

30
Q

What is the key test for Addison’s disease and how does it work?

A

Synacthen test

Measure cortisol levels before then after IV ACTH

31
Q

What is the treatment for Addison’s disease + what they are means to replace?

A 
Hydrocortisone = cortisol
Fludrocortisone = aldosterone
32
Q

What is the treatment for an Addisonian crisis?

A

Hydrocortisone

Saline/dextrose

33
Q

What are sick day rules for Addison’s disease?

A

Keep taking steroids

Double hydrocortisone if high temp

34
Q

What is a phaeochromocytoma, what cell does it come from + what do they secrete?

A

Adrenal medulla tumour
Chromaffin cells
Catecholamines

35
Q

What are phaeochromocytomas a cause of?

A

Secondary hypertension

36
Q

What do phaeochromocytomas look like?

A

Necrotic
Yellow
Haemorrhages
Nests of cells

37
Q

What is the classic triad of phaechromocytomas?

A

Hypertension (50% paroxysmal)
Sweating
Headaches

37
Q

Chromaffin cells on biopsy turn chromate to what colour?

A

Brown

38
Q

Name 5 conditions phaeochromocytomas are linked to.

A 
VHL syndrome
MEN 2
Succinate dehydrogenase mutations
NF
TS
40
Q

What are BG, Ca and K levels like in phaeochromocytomas?

A

High BG
Low Ca
Low K

41
Q

Name 2 tests for phaeochromocytomas?

A

CT or MIBG scan

Urinary catecholamines

41
Q

What is the treatment for phaeochromocytomas + example?

A

Alpha-blocker = phenoxybenzamine
Beta-blocker = propanolol
Fluids
Surgery

41
Q

What is the rule of 6 10s for phaeochromocytomas?

A 
10% extra-adrenal
10% bilateral 
10% malignant
10% hyperglycaemia 
10% children
10% familial

Year 2 MBChB Endocrine (14 decks)

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