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MEH > Adrenal Disorders > Flashcards

Adrenal Disorders Flashcards

1
Q

What are the clinical presentations of adrenal cortex disease?

A

Adrenal hormone deficiency
Adrenal hormone excess
ACTH excess from pituitary

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2
Q

What hormones may deficient in adrenal cortex diseases and what affect does this have?

A

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

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3
Q

Why is Hyperkalaemia dangerous?

A

K+ critical to normal functioning of the nerves and muscles

High K+ is dangerous for the heart so can cause cardiac arrest

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4
Q

What hormones may be in excess in an adrenal cortex disease and what affect does this have?

A

Cortisol = weight gain and Cushingoid features

Mineralocorticoid = high BP , Hypernatremia (High Na) and low K (hypokalemia)

Androgen = increased male characteristics in women

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5
Q

What does excess ACTH from pituitary often cause and why?

A

Skin pigmentation
POMC is a precursor for ACTH it also makes MSH which stimulates melanocytes

Seen in Addisons and ACTH driven Cushing’s

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6
Q

How does an adrenal medulla disease present?

A

Excess Catecholamines are produced causing:

Acute episodes
Sweating
Anxiety
Palpitations
High or low BP
Collapse
Sudden death

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7
Q

In aldosterone deficiency which electrolytes will be low and which electrolytes will be high?

A

Low Na+ hyponatremia
High K+ hyperkalemia

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8
Q

If testing cortisol levels to test for cortisol deficiency, what time should the test be done? And why?

A

9am 0900

This is when cortisol is supposed to be at its highest
If levels are low here it indicates deficiency

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9
Q

If you suspect an adrenal hormone deficiency what type of test can be done to check?

A

Stimulation test

Inject synthetic ACTH
SynACTHen

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10
Q

Generally , if you suspect and adrenal hormone excess, what should you do?

A

Try and suppress the suspected excess hormone

E.g Dexamethasone suppression test

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11
Q

If aldosterone is in excess, what will the electrolytes and BP be like?

A

High BP
Low K+

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12
Q

If cortisol is suspected to be in excess, when would you test cortisol levels and why?

A

Midnight
This is when it’s supposed to be the lowest

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13
Q

How can you assess the adrenal medullas functioning?

A

Take 24hr urine Catecholamines
Take 24hr metanephrines (breakdown product of adrenaline and noradrenaline)

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14
Q

What radiological assessments can be carried out to assess adrenal disease?

A

CT scan
MRI scan
PET scan

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15
Q

What are the symptoms of Addison’s disease?

A

Fatigue
Weakness
Anorexia
Weight loss
Nausea
Abdominal pain
Dizziness = aldosterone deficiency?
Pigmentation = ACTH excess?

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16
Q

What is Addison’s disease?

A

Chronic cortisol deficiency due to adrenal insufficiency

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17
Q

What are the signs of Addison’s disease?

A

Underweight
Signs of weight loss
Bernal malaise
Other auto-immune disease
Vitiligo
Postural hypotension
Pigmentation

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18
Q

What are the causes of primary adrenal failure?

A

Autoimmune
Infection
Infiltration (Haemochromatosis=excess iron deposition)
Malignancy
Genetic

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19
Q

What are the clinical features of an adrenal/Addisonian crisis?

A

Collapse
Hypotension
Dehydration
PIGMENTATION
Coma

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20
Q

What hormone is often low in an Adrenal crisis?

A

Cortisol

21
Q

How is an Adrenal/Addisonian crisis treated?

A

Rapid rehydration
Intravenous hydrocortisone (glucocorticoid)
Correct the hypoglycaemia
Find cause of adrenal crisis

22
Q

What is given to patient ps to treat Addison’s disease long term?

A

Glucocorticoids
Mineralocorticoids

23
Q

What occurs when ACTH is deficient?

A

No pigmentation
No hyperkalaemia since no Mineralocorticoid is being made to stimulateK+ being pumped back in at kidneys
Hyponatraemia

24
Q

Why must a patient not suddenly stop taking their steroid drugs?

A

The exogenous steroids lead to the suppression of ACTH since body needs to produce less corticosteroid

Sudden removal can cause hypo adrenal crisis

25
Q

What is Cushing’s syndrome caused by?

A

Excess Glucocorticoids (cortisol)

26
Q

What are presentations of Cushing’s syndrome?

A

Moon shaped face
Central obesity (round abdomen)
Purple striae
High BP and diabetes
Osteoporosis

27
Q

What can cause Cushing’s syndrome?

A

Pituitary tumour (too much ACTH)
Adrenal tumour
Ectopic ACTH

28
Q

What is adrenal Cushing’s syndrome?

A

Where an adrenal tumour is secreting glucocorticoids or cortisol metabolites

29
Q

What is the most important enzyme in the synthesis of corticosteroid hormones from cholesterol?

A

21-hydroxylase

30
Q

In adrenal Cushing’s syndrome, what will the levels of ACTH be like?

A

Suppressed/low it’s ACTH independent
The high levels of corticosteroids being produced suppresses the production of ACTH

31
Q

What androgen symptoms may be present in Adrenal Cushing’s syndrome?

A

Hirsutism
Acne
Greasy skin
Deep voice
Clitormegaly

32
Q

How is adrenal Cushing’s syndrome treated?

A

Surgery
Adrenalectomy

33
Q

What is primary Hyperaldosteronism?

A

Excess production of aldosterone from adrenal gland

34
Q

What are the 2 causes of Primary Hyperaldosteronism?

A

Aldosterone secreting adrenal adenoma = CONNS SYNDROME

Bilateral adrenal hyperplasia (no discrete adenoma)

35
Q

What is Conns Syndrome?

A

A type of primary Hyperaldosteronism caused by an adrenal tumour producing aldosterone

36
Q

What 2 signs does Primary Hyperaldosteronism cause?

A

Hypertension (High BP)
Hypokalaemia

37
Q

If you have hypertension and hypokalaemia, what ratio would confirm the Primary type of Hyperaldosteronism?

A

High aldosterone and low/suppressed renin levels

38
Q

What is Congenital Adrenal Hyperplasia (CAH)?

A

Caused by a block in adrenal cortex pathway due to deficiency in enzyme 21-hydroxylase

39
Q

What adrenal corticosteroid hormones are high and low in Congenital Adrenal Hyperplasia?

A

High male Sex hormones (androgens)
Low Mineralocorticoids
Low glucocorticoids

40
Q

What does CAH cause?

A

Adrenal/Addisonian crisis
Ambiguous GENITALIA

41
Q

How does Congenital Adrenal Hyperplasia (CAH) present?

A

Hypotension
Hyponatraemia
Hyperkalaemia
Hypoglycaemia
Virlisation = female develops male characteristics

42
Q

What is a Phaeochromocytoma?

A

Tumour of the adrenal medulla

43
Q

What is a paraganlioma?

A

Extra adrenal tumour of chromaffin tissue origin

44
Q

What is a chromaffin cell?

A

Cell that produces Catecholamines like adrenaline and noradrenaline
They are specialised post ganglionic neurones

45
Q

What are the symptoms of Phaeochromocytoma and parganglioma?

A

Acute episodes
Sweating
Panic attacks
Palpitations
High or low BP
Collapse

Since excess Catecholamines are being made (adrenaline and noradrenaline)

46
Q

What can happen in an acute crisis of Phaeochromocytoma and paraganglioma?

A

Sudden death
Cardia arrhythmias
Hyperglycaemia
Encephalopathy
Hypertensive crisis

47
Q

How do you investigate Phaeochromocytoma and paraganglioma?

A

24hr urine metanephrines

48
Q

How do you manage Phaeochromocytoma and paraganlioma?

A

Alpha blockade first (phenoxybenzamine)
Beta blockage (bisoprolol)
Surgical excision

49
Q

What type of disorders should you think with Phaeochromocytoma and paraganglioma?

A

Genetic disorder

MEH (33 decks)

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