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Endocrine > Adrenal disorders > Flashcards

Adrenal disorders Flashcards

1
Q

what hormones are present in the arenal medulla

A

catecholamines- adrenaline and noradrenaline

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2
Q

what is aldosterone regulated by?

A

renin angiotensin system

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3
Q

what is cortisol and androgen regulated by

A

hypothalamus and pituitary secretions

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4
Q

when is renin angiotensin system activated?

A

in response to low blood pressure

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5
Q

what is the result of rennin angiotensin system activation?

A

vasoconstriction and BP increase

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6
Q

do corticosteroids bind intracellularly oro extracellularly

A

intracellularly

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7
Q

what are the 6 classes of steroid receptors

A

glucocorticoid, mineralocorticoid, progestin, oestrogen, androgen, vitamin D

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8
Q

what does cortisol do to the bones/ connective tissue?

A

decrease wound healing, calcium, collagen formation, accelerates osteoporosis

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9
Q

what 3 things do steroids do?

A

suppress inflammation, immune system and replacement treatment

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10
Q

what is the best route of administration

A

oral

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11
Q

what effects does aldosterone have

A

sodium/ potassium balance, BP regulation and regulation of extracellular volume

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12
Q

what is the commonest cause of adrenal insufficiency

A

Addisons

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13
Q

how much of the adrenal cortex is destroyed before symptoms present in Addisons

A

90%

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14
Q

how do you diagnose adrenal insufficiency

A

suspicious biochemistry, synacthen test, ACTH levels, renin/aldosterone levels, adrenal autoantibodies

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15
Q

how do you manage adrenal insufficiency

A

1- hydrocortisone, 2- fludrocortisone as aldosterone replacement 3- wear identification, cant stop suddenly

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16
Q

what is the commonest cause of secondary adrenal insufficency

A

exogenous steroid use

17
Q

how do you treat sec adrenal insufficiency

A

hydrocortisone- dont need fludrocortisone

18
Q

what are signs typical of cushings

A

female, striae, amenorrhoea, easy bruising, myopathy

19
Q

what is the commonest cause of cushings syndrome?

A

ACTH dependent pituitary adenoma (cushings disease

20
Q

how do you diagnose cushings?

A

establish cortisol excess, overnight dexamethasone suppression test, cortisol.

21
Q

what is the commonest iatrogenic cause of cortisol excess

A

long term steroid use- suppression of pituitary ACTH and adrenal atrophy

22
Q

hypertension is common in what disorder?

A

primary aldosteronism or Conns

23
Q

how do you diagnose primary aldosteronism

A

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

24
Q

what is the management of primary aldosteronism

A

surgical- adrenalectomy, only adrenal adenoma

medical- bilateral adrenal hyperplasia- spironolactone

25
Q

how does congenital adrenal hyperplasia present

A

male, poor weight gain, acne, adrenal insufficiency, infertility,

26
Q

treatment of congenital adrenal hyperplasia

A

paeds- glucocorticoid replacement, mineralocorticoid replacement in some, surgical correction

adults- control androgen excess, restore fertility, avoid over use of steroiids

27
Q

what are some clues for phaeochromocytoma

A

labile hypertension, postural hypotension, paroxysmal sweating, headache, pallor, tachycardia

28
Q

what is the 10% tumour?

A

phaeochromocytoma

29
Q

what is the classical presentation triad of phaeocromocytoma

A

sweating ,headache, hypertension

30
Q

what are some biochemical abnormalities in phaeochromocytoma

A

hyperglycaemia, low potassium, hypercalcaemia, high haematocrit?

31
Q

what should the treatment be for phaeochromocytoma

A

a blocker- phenoxybenzamine and b blocker- propranolol, fluid replacement

surgical laparoscopic, chemotherapy if malignant, genetic testing

32
Q

what form of MEN is tumour suppressing

A

MEN1

33
Q

What is MEN2

A

proto oncogene

Endocrine (23 decks)

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