Adrenal disorders Flashcards
what hormones are present in the arenal medulla
catecholamines- adrenaline and noradrenaline
what is aldosterone regulated by?
renin angiotensin system
what is cortisol and androgen regulated by
hypothalamus and pituitary secretions
when is renin angiotensin system activated?
in response to low blood pressure
what is the result of rennin angiotensin system activation?
vasoconstriction and BP increase
do corticosteroids bind intracellularly oro extracellularly
intracellularly
what are the 6 classes of steroid receptors
glucocorticoid, mineralocorticoid, progestin, oestrogen, androgen, vitamin D
what does cortisol do to the bones/ connective tissue?
decrease wound healing, calcium, collagen formation, accelerates osteoporosis
what 3 things do steroids do?
suppress inflammation, immune system and replacement treatment
what is the best route of administration
oral
what effects does aldosterone have
sodium/ potassium balance, BP regulation and regulation of extracellular volume
what is the commonest cause of adrenal insufficiency
Addisons
how much of the adrenal cortex is destroyed before symptoms present in Addisons
90%
how do you diagnose adrenal insufficiency
suspicious biochemistry, synacthen test, ACTH levels, renin/aldosterone levels, adrenal autoantibodies
how do you manage adrenal insufficiency
1- hydrocortisone, 2- fludrocortisone as aldosterone replacement 3- wear identification, cant stop suddenly
what is the commonest cause of secondary adrenal insufficency
exogenous steroid use
how do you treat sec adrenal insufficiency
hydrocortisone- dont need fludrocortisone
what are signs typical of cushings
female, striae, amenorrhoea, easy bruising, myopathy
what is the commonest cause of cushings syndrome?
ACTH dependent pituitary adenoma (cushings disease
how do you diagnose cushings?
establish cortisol excess, overnight dexamethasone suppression test, cortisol.
what is the commonest iatrogenic cause of cortisol excess
long term steroid use- suppression of pituitary ACTH and adrenal atrophy
hypertension is common in what disorder?
primary aldosteronism or Conns
how do you diagnose primary aldosteronism
aldosterone excess- plasma aldosterone and renin and express as ratio. Fail of plasma aldosterone to suppress by >50% with 2 litres= PA
confirm subtype- CT to demonstrate adenoma
what is the management of primary aldosteronism
surgical- adrenalectomy, only adrenal adenoma
medical- bilateral adrenal hyperplasia- spironolactone
how does congenital adrenal hyperplasia present
male, poor weight gain, acne, adrenal insufficiency, infertility,
treatment of congenital adrenal hyperplasia
paeds- glucocorticoid replacement, mineralocorticoid replacement in some, surgical correction
adults- control androgen excess, restore fertility, avoid over use of steroiids
what are some clues for phaeochromocytoma
labile hypertension, postural hypotension, paroxysmal sweating, headache, pallor, tachycardia
what is the 10% tumour?
phaeochromocytoma
what is the classical presentation triad of phaeocromocytoma
sweating ,headache, hypertension
what are some biochemical abnormalities in phaeochromocytoma
hyperglycaemia, low potassium, hypercalcaemia, high haematocrit?
what should the treatment be for phaeochromocytoma
a blocker- phenoxybenzamine and b blocker- propranolol, fluid replacement
surgical laparoscopic, chemotherapy if malignant, genetic testing
what form of MEN is tumour suppressing
MEN1
What is MEN2
proto oncogene
