Adrenal disorders Flashcards
What are the corticosteroids?
What part of the adrenal gland are they each made?
Glomerulosa: Mineralcorticoids- aldosterone
Fasciculata: Glucocorticoid-cortisol
Reticularis: Sex steroids-androgens
What is Addison’s disease?
How does it present?
Autoimmune Adrenal failure of adrenal cortex = no aldosterone or cortisol
Symptoms: low blood pressure
Weight loss
Darker skin (due to MSH being cleaved as a result of ACTH produced)
Nausea
Hyponatraemia
Hyperkalaemia
What are the causes of adrenocortical failure?
Tuberculosis addisons
Autoimmune addisons
Congenital
How do we test for Addisons?
9am cortisol
ACTH
Short synACTHen test
How do you treat adrenocortical failure?
Which one needs to be given in an acute situation?
Hydrocortisone 3x a day
Prednisolone 1x a day (both glucocorticoid replacement)
Fludrocortisone (mineralocrticoid replacement )
Hydrocortisone- as it’s the glucocorticoid
What is 21-hydroxylase deficiency?
How does it present?
What is survival rate?
Congenital deficiency in the partial or complete enzyme causing hormone deficiency
Decreases production of aldosterone and cortisol and increase in sex steroids
Boys will often be missed to have it
Babies will die within a couple weeks due to salt crisis
How does partial 21 hydroxylase present?
Hirsutism
Virilisation
Menstrual irregularity
Clitoral enlargement
Small breast
Acne
Too much testosterone - early puberty
What is Cushings disease?
How does it present?
Too much cortisol
Presents: moon face, stretch marks, weight gain, skin thinning, hypertension, bruising
What are the three investigations to diagnose cushings?
What action will be hard for a patient with cushings to perform?
24hr urine collection for free urine cortisol
Late night cortisol levels
Low dose dexamethasone suppression test- cushings will fail to suppress cortisol
Squatting due to the proximal myopathy and peripheral oedema
What drugs are given to cushings and what do they each target?
When are they each given?
Metyrapone- 11-hydroxylase inhibitor
Given prior to surgery or to control radiotherapy
Ketoconazole- 17-hydroxylase inhibitor
Given prior to surgery
What are the adverse effects of metyrapone and ketoconazole?
Metyrapone- hypertension and hirsutism
Ketoconazole- liver damage
What surgical options are there for cushings?
Pituitary surgery
Bilateral or unilateral adrenalectomy
What is Conn’s syndrome?
What is another medical term for it?
How does It present?
Benign adrenal adenoma in zonal glomerulosa causing excess aldosterone
Primary hyperaldosteronism
Hypertension and hypokalaemia
What are the treatments for Conns syndrome?
Spironolactone- acts as a mineralcorticoid receptor antagonist = blocks na+ réabsorption in tubules = no aldosterone function
What are phaeochromocytomas?
How does It present?
What are two severe complications?
Tumours on adrenal medulla causing catecholamines eg noradrenaline and Adrenalin
Presents: hypertension, high metabolic rate, high heart rate, high blood glucose
Ventricular fibrillation and myocardial infarction
