Adrenal disorders Flashcards
32 year old female Lethargic Hypotensive Craves salty foods Pigmented buccal mucosa
Addisons
What is addisons disease?
Adrenal gland insufficieny
What is the most common cause of addison disease?
Autoimmune
What test would you order is you suspected addisons?
Short synacthen test
Describe the short synacthen test
- Measure cortisol levels
- Give injection of synacthen (synthetic ACTH)
- Measure cortisol 30mins later
What is the treatment for addisons?
Hydrocortisone and fludrocortisone replacement
What will the renin and aldosterone levels be like in addisons?
High renin
Low aldosterone
What will the ACTH levels be like in autoimmune addisons?
High
What are the results of a short synacthen test in a normal, healthy patient?
Baseline >250nmol/L, post ACTH >480
What is the commonest cause of secondary adrenal insufficiency?
Exogenous steroid use
How do you treat secondary adrenal insufficincy?
Hydrocortisone
17 year old female 3 year history of: Central weight gain Acne Amenorrhoea Hypertension Severe osteoporosis Proximal muscle weakness (myopathy)
Cushings
What tests confirm cushings?
Low dose dexamethasone suppression test
Overnight dexamethasone suppression test
What is meant by ACTH dependant cushings?
The reason for the cortisol excess is due to increased levels of ACTH
What is the most common cause of ACTH dependant cushings?
Pituitary adenoma
List a cause of ACTH independant cushings
Adrenal adenoma
Adrenal carcinoma
Nodular hyperplasia
34 year old male 1 year history of hypertension No other past medical history No regular medications On examination: BP 168/98 mm Hg Renal function normal but plasma potassium low
Primary hyperaldosteronism
What is conns syndrome?
An adrenal adenoma which causes primary hyperaldosteronism
What is the commonest cause of primary hyperaldosteronism?
bilateral adrenal hyperplasia
You suspect primary hyperaldosteronism in a patient. What do you do?
- Confirm aldosterone excess: Renin: Aldosterone ratio (renin low, aldosterone high, ration of over 750)
Saline suppression test. If there is a failure of plasma aldosterone to suppress by 50% with 2 litres saline then diagnois is confirmed. - Look for cause
- Adrenal CT
If there is an adenoma do renal vein sampling to check that this is the reason for the hyperaldosteronism.
How do you treat conns syndrome?
Laprascopic adrenalectomy
How do you treat bilateral adrenal hyperplasia?
Spiranolactone
What is the commonest enzyme deficiency that causes congenital adrenal hyperplasia?
21α hydroxylase
What is the inheritance pattern of congenital adrenal hyperplasia?
Autosomal recessive
A man presents with persistent hypertension, headaches and sweating.
Phaeochromcytoma
If you suspect phaechromaocytoma what test should you perforem
2 x 24 hrs catecholamines
If you suspect phaechromcytoma and get a positive 24hr urinary catecholamine result then what do you do?
MRI scan of abdomen or whole body
PET scan
How do you treat phasechromocytoma?
1. Alpha Blockade (Phenoxybenzamine) THEN 3. Beta blockade (Atenolol or metroprolol) Surgery Chemotherapy if malignanct
What is the inheritence pattern of MEN2?
Autosomal dominant
What is the mutation in MEN2?
Activating mutation in tyrosine kinase receptor.
What three conditions are associated with MEN2?
Medullary thyroid cancer
Parathyroid hyperplasia
Bilateral phaechromaocytoma
What is von huppel lindau syndrome?
A range of vascular tumours
What is the inheritence of von hippel lindau syndrome?
Autosomal dominant
