adrenal disease II

Question 1

What is Conn’s syndrome?

Answer 1

Mineralocorticoid excess

Primary hyperaldosteronism

Question 2

Why would you get hypokalaemia

Answer 2

initial retention of Na+ - water retention = increased K+ elimination -> hypokalaemia

Question 3

What’s the main clinical finding?

Answer 3

hypertension

Question 4

What are the treatment options?

Answer 4

surgery

aldosterone receptor antagonists

Question 5

what is Addison’s disease?

Answer 5

Primary adrenal insufficiency

failure of the adrenal glands

Question 6

What would you expect of the hormones from the adrenals, and the trophic hormones?

Answer 6

low aldosterone
low cortisol
low androgens

elevated ACTH

Question 7

List some symptoms of Addison’s disease

Answer 7

postural hypertension
muscle weakness, fatigue, lethargy 
hyponatraemia, hyperkalaemia 
increased pigmentation
weight loss
n&v

Question 8

What are some common causes of Addison’s

Answer 8

autoimmune, HIV or TB

Question 9

Why do you get increased pigmentation in Addison’s disease?

Answer 9

elevated ACTH = increased melanocyte-stimulating hormone (MSH)- increased melanin content in skin

Question 10

In Addison’s what would you expect the cortisol and ACTH to be?

Answer 10

low cortisol

increased ACTH

Question 11

ACTH stimulation test results?

Treatment options?

Answer 11

stimulation test - failure to increase cortisol using ACTH stimulation

long-life hormone replacement
glucocorticoids
high dose in morning then lower dose in afternoon to mimic the diurnal pattern.

Question 12

How can long-term use of glucocorticoids lead to adrenal atrophy?

Answer 12

leads to less ACTH (a GH) and so atropy of adrenal cortex

Question 13

What is secondary adrenal insufficiency?

Answer 13

lack of ACTH production (tumour/pituitary damage)

Question 14

What levels of cortisol and aldosterone wold you expect?

Answer 14

low cortisol

normal aldosterone levels (RAAs intact)

Question 15

what is acute adrenal insufficiency

Answer 15

long-term use of glucocorticoids
then sudden/abrupt withdrawal of exogenous steroids
= lack of corticoid activity

Question 16

What is adrenal crisis?

Answer 16

acute adrenal insufficiency and expressed when under stress

hypotension, circulatory failure, death

Question 17

What is congenital adrenal hyperplasia?

What’s the predominant enzyme missing?

Answer 17

inherited defect in an enzyme involved in the production of cortisol and aldosterone

21-beta-hydroxylase

Question 18

What’s the effect of a lacking ^ in females?

Answer 18

creates decreased levels of aldosterone and cortisol = accumulation of androgens

• born with ambiguous genitalia resulting in incorrect gender assignment

Question 19

why would you get hyperplasia of the adrenal glands and an excess of androgens in CAH?

Answer 19

low cortisol means reduced nagtive feedback inhibition for ACTH
ACTH is a trophic hormone - stimulate growth of adrenal cortex = adrenal hyperplasia = increased production of androgens as a result

Question 20

What’s the treatment for CAH?

Answer 20

Hormone replacement - give glucocorticoids
corrects negative feedback

gender assignment - can get plastic surgery