Adrenal Disorders Flashcards
What are the clinical presentations of adrenal cortex disease?
Adrenal hormone deficiency
Adrenal hormone excess
ACTH excess from pituitary
What hormones may deficient in adrenal cortex diseases and what affect does this have?
Cortisol deficiency = weakness, tiredness, weight loss, hypoglycaemia
Mineralocorticoid = dizziness, low Na (hyponatraemia), high K (Hyperkalemia)
Androgen = low libido and loss of body hair in women
Why is Hyperkalaemia dangerous?
K+ critical to normal functioning of the nerves and muscles
High K+ is dangerous for the heart so can cause cardiac arrest
What hormones may be in excess in an adrenal cortex disease and what affect does this have?
Cortisol = weight gain and Cushingoid features
Mineralocorticoid = high BP , Hypernatremia (High Na) and low K (hypokalemia)
Androgen = increased male characteristics in women
What does excess ACTH from pituitary often cause and why?
Skin pigmentation
POMC is a precursor for ACTH it also makes MSH which stimulates melanocytes
Seen in Addisons and ACTH driven Cushing’s
How does an adrenal medulla disease present?
Excess Catecholamines are produced causing:
Acute episodes
Sweating
Anxiety
Palpitations
High or low BP
Collapse
Sudden death
In aldosterone deficiency which electrolytes will be low and which electrolytes will be high?
Low Na+ hyponatremia
High K+ hyperkalemia
If testing cortisol levels to test for cortisol deficiency, what time should the test be done? And why?
9am 0900
This is when cortisol is supposed to be at its highest
If levels are low here it indicates deficiency
If you suspect an adrenal hormone deficiency what type of test can be done to check?
Stimulation test
Inject synthetic ACTH
SynACTHen
Generally , if you suspect and adrenal hormone excess, what should you do?
Try and suppress the suspected excess hormone
E.g Dexamethasone suppression test
If aldosterone is in excess, what will the electrolytes and BP be like?
High BP
Low K+
If cortisol is suspected to be in excess, when would you test cortisol levels and why?
Midnight
This is when it’s supposed to be the lowest
How can you assess the adrenal medullas functioning?
Take 24hr urine Catecholamines
Take 24hr metanephrines (breakdown product of adrenaline and noradrenaline)
What radiological assessments can be carried out to assess adrenal disease?
CT scan
MRI scan
PET scan
What are the symptoms of Addison’s disease?
Fatigue
Weakness
Anorexia
Weight loss
Nausea
Abdominal pain
Dizziness = aldosterone deficiency?
Pigmentation = ACTH excess?
What is Addison’s disease?
Chronic cortisol deficiency due to adrenal insufficiency
What are the signs of Addison’s disease?
Underweight
Signs of weight loss
Bernal malaise
Other auto-immune disease
Vitiligo
Postural hypotension
Pigmentation
What are the causes of primary adrenal failure?
Autoimmune
Infection
Infiltration (Haemochromatosis=excess iron deposition)
Malignancy
Genetic
What are the clinical features of an adrenal/Addisonian crisis?
Collapse
Hypotension
Dehydration
PIGMENTATION
Coma
What hormone is often low in an Adrenal crisis?
Cortisol
How is an Adrenal/Addisonian crisis treated?
Rapid rehydration
Intravenous hydrocortisone (glucocorticoid)
Correct the hypoglycaemia
Find cause of adrenal crisis
What is given to patient ps to treat Addison’s disease long term?
Glucocorticoids
Mineralocorticoids
What occurs when ACTH is deficient?
No pigmentation
No hyperkalaemia since no Mineralocorticoid is being made to stimulateK+ being pumped back in at kidneys
Hyponatraemia
Why must a patient not suddenly stop taking their steroid drugs?
The exogenous steroids lead to the suppression of ACTH since body needs to produce less corticosteroid
Sudden removal can cause hypo adrenal crisis
What is Cushing’s syndrome caused by?
Excess Glucocorticoids (cortisol)
What are presentations of Cushing’s syndrome?
Moon shaped face
Central obesity (round abdomen)
Purple striae
High BP and diabetes
Osteoporosis
What can cause Cushing’s syndrome?
Pituitary tumour (too much ACTH)
Adrenal tumour
Ectopic ACTH
What is adrenal Cushing’s syndrome?
Where an adrenal tumour is secreting glucocorticoids or cortisol metabolites
What is the most important enzyme in the synthesis of corticosteroid hormones from cholesterol?
21-hydroxylase
In adrenal Cushing’s syndrome, what will the levels of ACTH be like?
Suppressed/low it’s ACTH independent
The high levels of corticosteroids being produced suppresses the production of ACTH
What androgen symptoms may be present in Adrenal Cushing’s syndrome?
Hirsutism
Acne
Greasy skin
Deep voice
Clitormegaly
How is adrenal Cushing’s syndrome treated?
Surgery
Adrenalectomy
What is primary Hyperaldosteronism?
Excess production of aldosterone from adrenal gland
What are the 2 causes of Primary Hyperaldosteronism?
Aldosterone secreting adrenal adenoma = CONNS SYNDROME
Bilateral adrenal hyperplasia (no discrete adenoma)
What is Conns Syndrome?
A type of primary Hyperaldosteronism caused by an adrenal tumour producing aldosterone
What 2 signs does Primary Hyperaldosteronism cause?
Hypertension (High BP)
Hypokalaemia
If you have hypertension and hypokalaemia, what ratio would confirm the Primary type of Hyperaldosteronism?
High aldosterone and low/suppressed renin levels
What is Congenital Adrenal Hyperplasia (CAH)?
Caused by a block in adrenal cortex pathway due to deficiency in enzyme 21-hydroxylase
What adrenal corticosteroid hormones are high and low in Congenital Adrenal Hyperplasia?
High male Sex hormones (androgens)
Low Mineralocorticoids
Low glucocorticoids
What does CAH cause?
Adrenal/Addisonian crisis
Ambiguous GENITALIA
How does Congenital Adrenal Hyperplasia (CAH) present?
Hypotension
Hyponatraemia
Hyperkalaemia
Hypoglycaemia
Virlisation = female develops male characteristics
What is a Phaeochromocytoma?
Tumour of the adrenal medulla
What is a paraganlioma?
Extra adrenal tumour of chromaffin tissue origin
What is a chromaffin cell?
Cell that produces Catecholamines like adrenaline and noradrenaline
They are specialised post ganglionic neurones
What are the symptoms of Phaeochromocytoma and parganglioma?
Acute episodes
Sweating
Panic attacks
Palpitations
High or low BP
Collapse
Since excess Catecholamines are being made (adrenaline and noradrenaline)
What can happen in an acute crisis of Phaeochromocytoma and paraganglioma?
Sudden death
Cardia arrhythmias
Hyperglycaemia
Encephalopathy
Hypertensive crisis
How do you investigate Phaeochromocytoma and paraganglioma?
24hr urine metanephrines
How do you manage Phaeochromocytoma and paraganlioma?
Alpha blockade first (phenoxybenzamine)
Beta blockage (bisoprolol)
Surgical excision
What type of disorders should you think with Phaeochromocytoma and paraganglioma?
Genetic disorder
