Adrenal Disease Flashcards
Name 2 causes of primary hyperaldosteronism and what is hyperalodsteronism the main cause of?
Bilateral adrenal hyperplasia
Conn’s syndrome
Secondary hypertension
What is BP, Ca and K levels in primary hyperaldosteronism?
High BP
Low Ca
Low K
Explain the screening tests for primary hyperaldosteronism + positive result?
A:R ration
If raised do 2L saline suppression
Diagnosed if fail to suppress by 50%
Name 2 diagnostic tests for primary hyperaldosteronism.
Adrenal CT
Adrenal vein sampling
What is the treatment for Conn’s + bilateral hyperplasia primary hyperaldosteronism?
Conn’s = adrenalectomy
Bilateral hyperplasia = spironolactone
What is Conn’s syndrome and what is it usually caused by?
Primary hyperaldosteronism
Adrenocorticol adenoma
What is congenital adrenocorticol hyperplasia caused by + effect + inheritance?
Lack of 21 alpha hydroxylase
Can’t synthesise steroids
AR
Name 2 causes of acquired adrenocorticol hyperplasia?
Cushing’s syndrome
Paraneoplastic syndrome
Name 3 effects of steroid deficiency in adrenocorticol hyperplasia.
High androgens
High ACTH
Low cortisol
Low aldosterone
Name 4 signs of adrenocorticol hyperplasia.
Salt-wasting
Malnourishment
Scrotum hyperpigmentation
Female genital amiguity
Test for adrenocorticol hyperplasia?
Stimulated progesterone
What is hypercortisolism caused by + 2 types with an example?
Cushing’s
Exogenous = steroids
Endogenous = ACTH
Treatment for adrenocorticol hyperplasia?
Steroid replacement
Androgen reduction
Surgery
What are the 2 types of acquired adrenocorticol hyperplasia + role of ACTH?
Diffuse = ACTH driven Nodular = ACTH independent
What is the only definite diagnostic criteria for a malignant adrenocorticol tumour?
Metastasis
Name 4 red flag signs for an adrenocorticol mass.
> 50g
Haemorrhage
Necrosis
Capsular/vascular invasion
What are the 2 main adrenal medullary tumours?
Neuroblastoma
Phaeochromocytoma
Name 4 causes of primary adrenal insufficiency starting with the commonest.
Addison’s disease
Congenital adrenal hyperplasia
Tumours
Adrenal TB
Name 2 causes of secondary adrenal insufficiency?
Hypothalamic/pituitary tumours
Exogenous steroids
What does a adrenocorticol adenoma look like and is it functional/non-functional + mutation?
Small Yellow Even borders Non-functional KCNJ5
What are the features of an andrenocorticol carcinoma?
Functional
Metastasis
Capsular/vascular invasion
What is Addison’s disease + key antibody and what % its present in?
Autoimmune adrenaocorticol insufficiency
Anti-21-hydroxylase (70%)
What percentage of the adrenal glands are destroyed before Addison’s symptoms start?
> 90%
Name 6 signs of Addison’s disease?
Hyperpigmentation Dizziness Hypotension Weight loss GI upset Weakness
Name 3 causes of an Addisonian crisis.
Infection
Stress
Surgery
What is the Na and K levels in Addison’s disease?
Low Na
High K
Name 3 signs of an Addisonian crisis.
N and V
Abdominal pain
Shock
What is the key test for Addison’s disease and how does it work?
Synacthen test
Measure cortisol levels before then after IV ACTH
What is the treatment for Addison’s disease + what they are means to replace?
Hydrocortisone = cortisol Fludrocortisone = aldosterone
What is the treatment for an Addisonian crisis?
Hydrocortisone
Saline/dextrose
What are sick day rules for Addison’s disease?
Keep taking steroids
Double hydrocortisone if high temp
What is a phaeochromocytoma, what cell does it come from + what do they secrete?
Adrenal medulla tumour
Chromaffin cells
Catecholamines
What are phaeochromocytomas a cause of?
Secondary hypertension
What do phaeochromocytomas look like?
Necrotic
Yellow
Haemorrhages
Nests of cells
What is the classic triad of phaechromocytomas?
Hypertension (50% paroxysmal)
Sweating
Headaches
Chromaffin cells on biopsy turn chromate to what colour?
Brown
Name 5 conditions phaeochromocytomas are linked to.
VHL syndrome MEN 2 Succinate dehydrogenase mutations NF TS
What are BG, Ca and K levels like in phaeochromocytomas?
High BG
Low Ca
Low K
Name 2 tests for phaeochromocytomas?
CT or MIBG scan
Urinary catecholamines
What is the treatment for phaeochromocytomas + example?
Alpha-blocker = phenoxybenzamine
Beta-blocker = propanolol
Fluids
Surgery
What is the rule of 6 10s for phaeochromocytomas?
10% extra-adrenal 10% bilateral 10% malignant 10% hyperglycaemia 10% children 10% familial
