adrenal disease II Flashcards
What is Conn’s syndrome?
Mineralocorticoid excess
Primary hyperaldosteronism
Why would you get hypokalaemia
initial retention of Na+ - water retention = increased K+ elimination -> hypokalaemia
What’s the main clinical finding?
hypertension
What are the treatment options?
surgery
aldosterone receptor antagonists
what is Addison’s disease?
Primary adrenal insufficiency
failure of the adrenal glands
What would you expect of the hormones from the adrenals, and the trophic hormones?
low aldosterone
low cortisol
low androgens
elevated ACTH
List some symptoms of Addison’s disease
postural hypertension muscle weakness, fatigue, lethargy hyponatraemia, hyperkalaemia increased pigmentation weight loss n&v
What are some common causes of Addison’s
autoimmune, HIV or TB
Why do you get increased pigmentation in Addison’s disease?
elevated ACTH = increased melanocyte-stimulating hormone (MSH)- increased melanin content in skin
In Addison’s what would you expect the cortisol and ACTH to be?
low cortisol
increased ACTH
ACTH stimulation test results?
Treatment options?
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.
How can long-term use of glucocorticoids lead to adrenal atrophy?
leads to less ACTH (a GH) and so atropy of adrenal cortex
What is secondary adrenal insufficiency?
lack of ACTH production (tumour/pituitary damage)
What levels of cortisol and aldosterone wold you expect?
low cortisol
normal aldosterone levels (RAAs intact)
what is acute adrenal insufficiency
long-term use of glucocorticoids
then sudden/abrupt withdrawal of exogenous steroids
= lack of corticoid activity
What is adrenal crisis?
acute adrenal insufficiency and expressed when under stress
hypotension, circulatory failure, death
What is congenital adrenal hyperplasia?
What’s the predominant enzyme missing?
inherited defect in an enzyme involved in the production of cortisol and aldosterone
21-beta-hydroxylase
What’s the effect of a lacking ^ in females?
creates decreased levels of aldosterone and cortisol = accumulation of androgens
- born with ambiguous genitalia resulting in incorrect gender assignment
why would you get hyperplasia of the adrenal glands and an excess of androgens in CAH?
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
What’s the treatment for CAH?
Hormone replacement - give glucocorticoids
corrects negative feedback
gender assignment - can get plastic surgery
