Adrenal Disease Flashcards
Where are adrenal glands located?
What hormones does the adrenal cortex secrete and their actions?
Adrenal medulla?
2 glands, sit above kidney on each side, outer capsule, cortex and medulla.
Glucocorticoids (cortisone, cortisol): effects upon glucose, carbohydrate, fat and protein metabolism, Na and K balance, water balance, immune function. Cortisol has a weak mineralocorticoid effect too.
Mineralocorticoids (aldosterone): Na and K balance and BP, part of renin-angiotensin-aldosterone system
Androgens (dehydroepiandrosterone): peripherally converted to testosterone or dihydrotestosterone
Adrenal medulla:
Catecholamines (adrenaline/nor): stress hormones
What are the types of disease states associated with adrenal disease?
- adrenal glucocorticoid and mineralocorticoid excess: Cushings syndrome
- adrenal mineralocorticoid excess: hyperaldosteronism
- adrenal insufficiency: hypoadrenalism
What is cushings syndrome and its causes?
List its symptoms:
Cushings syndrome - excess cortisol and aldosterone
- usually due to iatrogenic glucocorticoid administration
- sometimes adrenal adenoma
- rarely pituitary adenoma or ectopic by malignant disease
Symptoms:
- weight gain, slow healing of cuts, increased risk of infection, fatigue, glucose intolerance, hyperglycaemia, headache, buffalo hump, moon face, muscle weakness (shoulder, hip), skin thinning, stretch marks, anxiety, depression, hypertension –> increased CVD risk
What is Hyperaldosteronism?
Symptoms?
Causes?
Hyperaldosteronism - adrenal mineralocorticoid excess
- hypertension - may be severe
- hypokalaemia, muscle weakness
Caused by:
- usually adrenal adenoma secreting aldosterone (Conns syndrome)
- sometimes due to adrenal hyperplasia
What is Hypoadrenalism?
Causes?
Symptoms?
Hypoadrenalism: adrenal insufficiency
Caused by:
- usually an autoimmune disease, more common in women, Addisons disease
- insifficient replacement in context of infection or stress
- less commonly TB, sepsis, malignant infiltration
Symptoms:
- often has insidious onset, symptoms are non-specific and overlap with other conditions
- may present with adrenal crisis (medical emergency), often precipitated by intercurrent infection or stress state
- more common in females
What investigations can be carried out for adrenal diseases?
- blood tests: plasma cortisol and ACTH, Na, K, glucose levels
- other blood tests: dexamethasome suppression tests
- adrenal imaging
- brain imaging
How is cushings syndrome treated?
List some dental aspects of cushings syndrome:
Treatment:
- reverse what is reversible - minimise dose of glucocorticoids
- surgical removal of adrenal or pituitary adenomas
- if untreated, consequences of hypertension and hyperglycaemia cause excess cardiovascular morbidity (IHD, CVD, CKD, PVD)
Dental aspects:
- hyperglycaemia and immune suppression - increased risk of oral infections (candida)
- poorer wound healing
- you may recognise features first –> refer to GP
Symptoms of adrenal crisis:
How is this treated?
Precipitated by incurrent infection or stress:
- hypotension, may collapse
- hypovolaemic shock (no BP)
- acute abdominal pain
- hypoglycaemia
- vomiting
- low grade fever
Treatment:
- hospitalise
- lie flat with raised legs
- if available: IV fluids, hydrocortisone injection 100mg after bloods have been taken
List some signs and symptoms of adrenal insufficiency if presenting sub-acutely:
How is adrenal insufficiency treated when presents sub-acutely?
What are sick day rules?
- weight loss, nausea, confusion, diarrhoea or constipation, low BP, loss of body hair, pigmentation of buccal mucosa
Treatment:
- replacement glucocorticoid (hydrocortisone) and mineralocorticoid (fludrocortisone) under action of an endocrinologist - life-long therapy needed
- steroid alert card to be carried
- increase dose of corticosteroid if under physical stress/infection/GA
Sick day rules: should double dose of hydrocortisone if prescribed with antibiotics for an infection until recovered
List some dental aspects of adrenal insufficiency:
- be aware - particularly in people on long term steroids
- buccal and facial pigmentation is a good clue –> refer to GP
- caution in surgery requiring GA in patients with adrenal insufficiency –> alert anaesthetist
