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Y2 Revision > Adrenal Disease > Flashcards

Adrenal Disease Flashcards

1
Q

what are the two main adrenal medullary tumours?

A

neuroblastoma

pheochromocytoma

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2
Q

from what cells is pheochromocytoma derived?

A

chromaffin cells of the adrenal medulla

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3
Q

what does pheochromocytoma secrete?

A

catecholamines

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4
Q

why is pheochromocytoma called the 10% tumour?

A

10% are extra adrenal
10% are bilateral
10% are malignant
10% are not associated with hypertension

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5
Q

which adrenal disorder is associated with dark skin?

A

addison’s disease (high ACTH)

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6
Q

what are the main primary adrenal insufficiencies?

A

addison’s disease
congenital adrenal hyperplasia
malignancy
adrenal TB

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7
Q

what is the most common cause of primary adrenal insufficiency?

A

addison’s disease

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8
Q

is addison’s disease an autoimmune disease?

A

yes

associated with autoantibodies in the majority of cases

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9
Q

list clinical features of addison’s disease

A 
dizziness
low BP 
fatigue 
anorexia 
skin pigmentation
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10
Q

what would sodium and potassium levels be like in addison’s disease?

A

low sodium

high potassium

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11
Q

which diagnostic test is used for Addison’s disease?

A

short synACTHen test

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12
Q

outline management for adrenal insufficiency

A

hydrocortisone 30mg

fludrocortisone

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13
Q

true or false: patients on hydrocortisone for adrenal insufficiency can stop whenever they want

A

false

never stop suddenly, but the dose can be reduced

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14
Q

list causes of secondary adrenal insufficiency

A

pituitary/hypothalamic tumours

exogenous steroid use

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15
Q

what is the effect of exogenous steroid on the H-P-adrenal cortext axis?

A

suppress CRH and ACTH

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16
Q

what hormone is in excess in cushing’s syndrome?

A

cortisole

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17
Q

true or false: cushing’s syndrome is more common in men

A

false

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18
Q

list clinical features of cushing’s syndrome

A 
moon face 
abdominal striae 
thin skin 
easy bruising 
proximal myopathy 
osteoporosis
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19
Q

what are the ACTH dependent causes of cushing’s syndrome?

A

pituitary disease/adenoma

ectopic tumours

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20
Q

what are ACTH independent causes of cushing’s syndrome?

A

adrenal disease/adenoma

nodular hyperplasia

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21
Q

what is the gold standard test for diagnosing cushing’s syndrome?

A

low dose dexamethasone suppression test

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22
Q

what is the most common cause of cortisol excess?

A

high dose steroid therapy

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23
Q

what is primary aldosteronism?

A

autonomous production of aldosterone independent of its regulators

24
Q

which syndrome occurs due to aldosteronism?

A

conn’s syndrome

25
Q

what is the most common cause of secondary hypertension?

A

primary aldosteronism

26
Q

outline how an aldosterone excess is diagnosed

A

measure aldosterone:renin ratio

if raised, do saline suppression test

failure of aldosterone to suppress by 50% with 2L saline confirms aldosteronism

27
Q

what are the main causes of aldosteronism?

A

adrenal hyperplasia
adrenal adenoma
genetic mutations

28
Q

outline management of primary aldosteronism

A

adrenalectomy if unilateral adenoma

spironolactone if bilateral hyperplasia

29
Q

what is the most common cause of congenital adrenal hyperplasia?

A

21-alpha-hydroxylase deficiency

30
Q

what three main effects does 21-alpha-hydroxylase deficiency cause?

A

low cortisol
low aldosterone
excess androgens

31
Q

what is the classical triad of symptoms in pheochromocytoma?

A

hypertension
headache
sweating

32
Q

how is pheochromocytoma diagnosed?

A

MRI
MIBG
PET scan

33
Q

outline therapy for pheochromocytoma

A

alpha blockers
beta blockers
fluid replacement
surgical excision

34
Q

pheochromocytoma is associated with which clinical syndromes?

A 
MEN 2
von hippel lindau 
succinate dehydrogenase mutations 
neurofibromatosis 
tuberous sclerosis
35
Q

which gene is affected in MEN 1?

A

MEN1 gene (11q)

36
Q

which gene is affected in MEN 2?

A

RET gene (10q)

37
Q

true or false: the MEN1 gene is a tumour suppressor

A

true

38
Q

is the RET gene a tumour suppressor or a proto-oncogene?

A

proto-oncogene

39
Q

von hippel lindau syndrome is caused by a mutation in which gene?

A

VHL gene

40
Q

list the parts of the adrenal gland

A

outer capsule
cortex
medulla

41
Q

what are the three zones located in the adrenal cortex?

A

zona glomerulosa
zona fasciculata
zona reticularis

42
Q

which cells are located in the adrenal medulla?

A

chromaffin cells

43
Q

what controls hormonal release in the zona glomerulosa?

A

RAAS (angiotensin II)

44
Q

which hormone is secrete from the zonua glomerulosa?

A

aldosterone

45
Q

what controls hormonal release in the zona fasciculata?

A

ACTH

46
Q

what hormones are secreted from the zona fasiculata?

A

cortisol

corticosterone

47
Q

what controls hormonal release in the zona reticularis?

A

ACTH

48
Q

what hormones are secreted from the zona reticularis?

A

androgens

49
Q

what controls hormonal release in the adrenal medulla?

A

sympathetic nervous system

50
Q

what hormones are secreted from the adrenal medulla?

A

catecholamines

51
Q

outline the hypothalamus pituitary adrenal cortex axis

A

HYPOTHALAMUS secretes CRH which stimulates anterior PITUITARY to secrete ACTH which stimulates the ADRENAL GLAND to secrete cortisol

52
Q

which part of the H-P-adrenal cortex axis does cortisol inhibit in negative feedback?

A

hypothalamus

anterior pituitary

53
Q

which system regulates aldosterone release?

A

RAAS

54
Q

what is the effect of cortisol upon the CNS?

A

varying mood
psychosis
loss of libido

55
Q

what is the effect of cortisol upon bone?

A

osteoporosis

56
Q

what is the effect of cortisol upon metabolism?

A

increases breakdown of carbs, lipids and proteins

57
Q

what are the main effects of aldosterone?

A

increased K + H ion excretion

sodium retention

Y2 Revision (95 decks)

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