Adrenal disease

Question 1

What are the three zones in the adrenal gland? and what hormones does each produce

Answer 1

GFR

Glomerulosa - produces aldosterone
Fasciculata - produces cortisol
Reticularis - produces androgens

Question 2

What kind of hormone is aldosterone?

Answer 2

mineralocorticoid

Question 3

What kind of hormone is cortisol?

Answer 3

glucocorticoid

Question 4

What does the medulla produce in the adrenal gland?

Answer 4

adrenalline

Question 5

What is the blood supply to the adrenal gland like?

Answer 5

Extensive arterial supply

only 1 vein

Question 6

What is the main cause of low aldosterone, low cortisol?

Answer 6

ADDISON’s DISEASE

Question 7

What are causes of Addison’s disease?

Answer 7

• TB: worldwide

- AI: UK

Question 8

What is Schmitt disease?

Answer 8

Addison’s + hypothyroidism

Question 9

What pituitary hormone triggers cortisol synthesis?

Answer 9

ACTH

Question 10

What are functions of cortisol?

Answer 10

Ubiquitous - as GC receptors are found almost everywhere in the body.

• Suppress IMMUNE RESPONSE
• STRESS RESPONSE
• CATABOLISM (gluconeogenesis, glycogenolysis, lipolysis, decreases insulin, increases glucagon)

Question 11

What are symptoms of Addisons?

Answer 11

Hypoglycaemia (cortisol deficiency)
Postural hypotension (aldosterone def)
Weakness, weight loss, fatigue 
Bronzed skin (due to excess compensatory ACTH, which activates melanocytes)
GI disturbance

Question 12

How do you investigate Addison’s?

Answer 12

Short SYNACTHEN test 
- measure cortisol and ACTH at start 
- then give synacthen 
- should stimulate cortisol production 
If it doesn't > ADDISON's

Question 13

What conditions does excess function of different areas of the adrenal gland also cause?

Answer 13

• Conn’s (aldosterone)
• Cushing’s (cortisol)
• pheochromocytoma (adrenaline)

Question 14

What are symptoms of phaeo?

Answer 14

hypertension
arrhythmia
death

Question 15

How do you treat phaeo?

Answer 15

alpha blocker
THEN beta blocker
THEN surgery

Question 16

What genetic conditions are linked to phaeo?

Answer 16

MEN2
Von Hippel Lindau
Neurofibromatosis Type 1

Question 17

What occurs in Conn’s syndrome?

Answer 17

High levels of aldosterone

Causes hypertension, suppresses renin at JGA

Question 18

How do you investigate COnn’s

Answer 18

Measure blood aldosterone (HIGH) and renin (LOW)

Question 19

What occurs in Cushing’s?

Answer 19

Excess cortisol production

Question 20

What are causes of Cushing’s syndrome?

Answer 20

1. Oral steroids
2. Cushing’s disease (pituitary tumour)
3. Adrenal adenoma
4. Ectopic ACTH

Question 21

What are investigations for Cushing’s?

Answer 21

9am cortisol, midnight cortisol (should be high in morning, low at night)
» but in Cushing’s both will be elevated

LOW DOSE DEXAMETHASONE SUPPRESSION TEST (give dex to suppress ACTH > should suppress cortisol production)
0.5mg dexamethasone every 6 h over 48h > measure cortisol

INFERIOR PETROSAL BLOOD SAMPLING

Question 22

What is the gold standard ix for Cushing’s disease

Answer 22

INFERIOR PETROSAL BLOOD SAMPLING

Question 23

what is an alpha blocker you can use to treat phaeo

Answer 23

phenoxybenzamine

OR
phentolamine
Doxazocin

Question 24

what is a low dose dexamethasone suppression test for

Answer 24

find out if the patient has Cushing’s syndorme

Question 25

what do you routinely do after a + LDDST

Answer 25

inferior petrosal blood sampling

Question 26

what will an inferior petrosal sinus sampling tell yo

Answer 26

if it is cushings DISEASE (aka pituitary adenoma, which is responsible for 85% of all cushings)

Question 27

what can you do instead of inferior petrosal sinus sampling

Answer 27

you can do a high dose dexamethasone suppression test

Question 28

what does a high dose dex suppression test involve

Answer 28

2mg dex everty 6 h

Question 29

what will a high dose dex suppression test tell you

Answer 29

if positive: that a pituitary tumour is the cause