adrenal disorders Flashcards
which adrenal gland is lower and why
the R adrenal gland is situated lower than the L due to the liver on the R side
where does blood from the R adrenal gland drain into
directly into the vena cava
where does blood from the L adrenal gland drain into
the adrenal vein
what are the 5 layers of the adrenal gland (out to in)
- capsule
- zona glomerulosa
- zona fascicilata
- zona reticularis
- adrenal medulla
(e)GFR -> order of layers
what is produced in the zona glomerulosa and what axis controls it
mineralcorticoids (aldosterone) -> controlled by RAS system
what is produced in the zona fasciculata and what axis controls it
glucocorticoids (cortisol) -> controlled by HPA-axis
what is produced in the zona reticulata and what axis controls it
sex hormones (adrenal androgens) -> controlled by HPA-axiswha
what is produced in the adrenal medulla and what controls it
catecholamines (adrenaline, NA, DA) -> controlled by symp nervous system
draw out the RAAS system
angiotensinogen –(renin)–> angiotenin I –(ACE)–> angiotensin II -> effects on adrenal glands and vasculature
what does decreased cortisol and decreased ACTH indicate
pituitary problem
what does increased aldosterone production lead to a decrease in
decrease in renin (-ve feedback loop)
what conditions present with low cortisol levels (3)
adenal failure
1. primary adrenal failure (addison’s, adrenalectomy, CAH etc.)
2. pituitary failure
3. exogenous steroids
what conditions present with high cortisol levels (3)
cushings syndrome:
1. adrenal
2. pituitary
3. ectopic ACTH
what 3 things must be proved for a diagnosis of addison’s disease
- primary adrenal failure
- autoimmune
- mineral AND gluco-corticoid deficiency
what conditions present with low aldosterone levels (4)
adrenal failure
1. addison’s
2. adrenalectomy
3. infections
4. Congenical adrenal hyperplasia (CAH)
what condition present with high aldosterone levels
Conn’s syndrome
what conditions present with high adrenal androgen levels
- CAH
- adrenal carcinoma
what condition presents with high catecholamine levels
pheochromoctyoma
mineralcorticoid pathway (cholesterol -> aldosterone)
cholesterol –(ACTH)–> pregnenolone -> progesterone -> 11-deoxycorticosterone -> corticosterone –(angiotensin II)–> 16-hydroxycorticosterone -> aldosterone
glucocorticoid pathway (cholesterol -> cortisol)
cholesterol –(ACTH)–> pregnenolone -> 17a-hydroxypregnenolone -> 17a-hydroxyprogesterone -> 11-deoxycortisol -> cortisol
androgen pathway (cholesterol -> oestrogen)
cholesterol –(ACTH)–> pregnenolone -> 17a-hydroxypregnenolone -> dehydroepiandrosterone (DHEA) -> androsternedione -> testosterone -> oestrogen
what are the 4 main problems that cause endocrine disorders
- hormone excess
- hormone deficency
- mass/nodules
- inflammation
what kind of hormone tests should be done for hormone excess diseases
suppression test
what kind of hormone tests should be done for hormone deficency diseases
stimulation test
what is important to consider when conducting a hormone test
time of day e.g. midnight for cushing’s and 9am for addison
why is hyperpigmentation seen in addison’s disease
melanocyte-stimulating hormone (MSH) and ACTH both share a precursor molecule - proopiomelanocortin => the gene that codes for ACTH also codes for MSH, ACTH can also bind to melanocortin 1 receptor on the surface of dermal melanocytes
addisonian crisis presentation (6)
- preceeding vague symptoms until pecipitating event
- sudden penetrating pain in lower back, abdomen or legs
- severe vomiting and diarrhoea
- dehyrdation
- hypotension (leading to shock)
- loss of concioussness
addisonian crisis Mgx (5)
- DONT DELAY (don’t wait for senior review) - give IV hydrocortisone
- take bloods and send for later (cortisol, ACTH, adrenal antibody measuremnt)
- 2-3L saline or colloid to restore BP
- 10% glucose of hypoglycaemic
- abx if signs of infection
addison’s disease presentation
- progressive weakness;
- fatiguability;
- GI disturbance;
- hyperpigmentation;
- decreased meralcorticoid activity (hyperkalemia, hyponatremia, hypotension);
- may present w acute adrenal crisis
4 causes of hypoadrenalism
- autoimmine adrenalitis (addison’s disease)
- TB
- AIDS
- metastatic cancer
what are sick day rules for addisonian pts
- double up on steroid dose for 48 hrs or until abx course is finished -> gradually taper down the dose to normal levels
- if vomiting up dose, imediately take double dose again, if this is then vomited up , inject yourself with 100mg of hydrocortisone and seek medical advice immediately
4 causes of a massive adrenal haemorrhage (precipitating factor for addisonian crisis)
- neonates
- anticoagulation therapy
- DIC post-surgery
- waterhouse-friderichsen syndrome (meningococcal septemsemia)
ECG wave denoting hypokalemia
U wave
what is wermer syndrome (MEN1)
adenomas that affect the pituitary, parathyroid, and pancreatic areas; Multiple adenomas gradually involve all four parathyroid glands; The first clinical sign of MEN1 includes recurrent nephrolithiasi
what is sipple syndrome (MEN IIA)
medullary thyroid cancer and noncancerous tumors of the parathyroid glands and adrenal glands
organs involved in wermer syndrome (5)
pituitary; parathyroid; pancreatic islet cells; adrenal; thyroid
organs involved in MEN IIB (3)
parathyroid; adrenal; thyroid
organs involved in MEN IIA (3)
parathyroid; adrenal; thyroid
what must be removed in those with MEN II
thyroid gland
what kind of appearance do MEN II pts have
marfans like
what does MEN stand for (e.g. MEN I, MEN IIA)
multiple endocrine neoplasia
what is Conn’s syndrome
a condition when the adrenal glands overproduce aldosterone - aka Primary Hyperaldosteronism
Conn’s symptoms
- HTN - usually hard to control
due to HTN: - headaches
- blurred vision
- dizziness
due to hypokalemia:
5. fatigue
6. numbness
7. increased thirst/urination
Conn’s mgx
depends on the cause
1. surgery - if caused by adrenal tumour
2. blood pressure mgx
3. diuretics - spironolactone
complications of Conn’s
high risk of cardiovascular events due to elevated BP
