Adrenal Diseases

Question 1

What is Addison’s Disease?

Answer 1

Being in a state of low cortisol and aldosterone production due to adrenal gland destruction

Question 2

What is the major cause of Addison’s Disease?

Answer 2

autoimmune:
- Ab secreted against the adrenal enzymes and 3 cortical zone
- polyglandular autoimmune syndrome type I and II

Question 3

What are the other causes of Addison’s Disease?

Answer 3

-Infection: TB, fungal, HIV, CMV
Infiltrative: metastatic cancer (lung>stomach>esophagus>colon>breast)
-Vascular: adrenal hemorrhage
-Drugs that inhibit cortisol: ketoconazole, megesterol acetate
-Drugs that reabsorb cortisol: rifampicin, phenytoin, barbiturates, heparin, coumadin
-Adrenoleukodystrophy

Question 4

What are the signs and symptoms of Addison’s Disease?

Answer 4

Dark palmar crease and extensor surface
High K+ low Na+
Low BP
Increased Urea

Question 5

whats tests would you order to diagnose Addison’s Disease and what would the results be?

Answer 5

Serum cortisol --> low 
ACTH --> High 
Synacthen test 
Detection of adrenal Ab 
Adrenal imaging where you would see calcification

Question 6

What is the treatment of Addison’s Disease?

Answer 6

Glucocorticoids:
  - cortisone acetate 
  - dexamethasone 
  - prednisolone 
Mineralocorticoids 
  -fludrocortisone

Question 7

What is the syndrome where there is increased aldosterone production from the adrenal CORTEX?

Answer 7

CONN’S SYNDROME

Question 8

What is the disease where there is increased catecolamine production from the adrenal MEDULLA?

Answer 8

PHAEOCHROMOCYTOMA

Question 9

What are the causes of Conn’s Syndrome?

Answer 9

Unilateral aldosterone producing adenoma (64%)
Idiopathic bilateral hyperaldosteronism
Aldosterone producing adrenal carcinoma

Question 10

What is the function of aldosterone?

Answer 10

Reabsorb sodium and water
Secrete K+
H+ secretion

Question 11

What are the symptoms of Conn’s Syndrome?

Answer 11

-HTN

• Hypokalemia
  headache, palpitations, polydipsia, polyuria, nocturia
• Metabolic alkalosis

Question 12

How do you diagnose Conn’s Syndrome?

Answer 12

• 24 hour urine collection to detect K+ in the urine which is causing the hypokalemia
• Plasma renin activity: would be suppressed
• Plasma urine aldosterone: will be high
• Aldosterone suppression failure after infusion of 2L N saline or high Na+ over 3 days
• High aldosterone-renin ratio
• CT/MRI
• I131- iodocholesterol scanning

Question 13

What is the treatment of Conn’s Disease?

Answer 13

Adrenal adenoma surgery
Aldactone
Amilorine

Question 14

what is the function of amiloride?

Answer 14

block Na+ channels in the proximal tubule thus decreasing K+ excretion

Question 15

what is the function of aldactone?

Answer 15

competitive antagonist to aldosterone

Question 16

What is phaeochromocytoma

Answer 16

Tumour of the chromaffin cells located in the adrenal medulla

Question 17

What are the clinical features of phaeochromocytoma

Answer 17

sudden and severe
spontaneous or elicited by exercise, bending over, defamation, abdominal pressure or drugs

You get:
pallor, perspiration, labile BP, headache

Question 18

How do you diagnose phaeochromocytoma

Answer 18

urine catecholamines over 24hours

plasma catecholamines

Question 19

how do you localise a phaeochromocytoma

Answer 19

CT scanning
MIBG scanning
Venous sampling
Octreotide scanning

Question 20

what is the pre-op treatment of phaeochromocytoma

Answer 20

• alpha-adrenergic blockade with phenoxybenamine
• beta blockers if necessary but also start with alpha blockage
• treat the arrhythmia, HF, diabetes as required