Adrenal Disorders

Question 1

Adrenal cortex produces

Answer 1

corticosteroids from cholesterol: mineraocorticoids (aldosterone), glucocorticoids (cortisol), gonadocorticoids (androgens)

Question 2

adrenal medulla produces

Answer 2

catecholamines (adrenaline)

Question 3

Cushings Syndrome

Answer 3

chronic hypercortisolism (prolonged exposure to cortisol) 
Abnormally high circulating level of glucocorticosteroid hormones

Question 4

Causes of Cushing’s Syndrome

Answer 4

adrenal gland tumour
prolonged admin of coricosteroid drugs
cushing’s disease: benign pituitary adenoma secreting ACTH
paraneoplastic cushing’s disease: tumours secreting ACTH outside of normal pituitary adrenal system

Question 5

Signs and symptoms of Cushing’s SYndrome

Answer 5

central obesity
lipodystrophy (buffalo lump on back of neck) 
red, flushed face
muscle atrophy and weakness
osteoporosis 
thinning skin, easily bruised
purple stretch marks on thighs, abdo, breasts 
hirsutism (male pattern facial hair)

Question 6

Cushingoid

Answer 6

cataracts, ulcers, hypertension, infection, nectrosis, glycosuria, osteroporosis, diabetes

Question 7

Treatment of Cushings syndrome

Answer 7

ceasing and corticosteroid meds
removal of any adrenal adenoma
bilateral adrenalectomy
admin of drugs which inhibit cortisol secretion

Question 8

Hyperadosteronism

Answer 8

hypersecretion of aldosterone by adrenal glands

results in hypokalaemia (lowered levels of potassium) and alkalosis via increase H+ ion excretion

Question 9

Primary and secondary acuses of hyperaldosteronism

Answer 9

Primary - conn’s syndrome (adrenal Adenoma), congenital adrenal hyperplasia
secondary - overactivity of the renin-angiotensin-aldosterone system, juxtaglomerular tumour, renal artery stenosis

Question 10

Signs and symptoms of hyperaldosteronism

Answer 10

hypertension, fatigue, headache, hypokalaemia, hypomagnesaemia, muscle spasms and weakness, polyuria, polydipsia, metabolic acidosis

Question 11

treatment of hyperaldosteronism

Answer 11

removal of the adenoma if possible

spironolactone (potassium sparing diuretic- aldosterone antagonist)

Question 12

Pheochromocytoma

Answer 12

tumour of the adrenal medulla resulting in a hypersecretion of catecholamines

Question 13

causes of pheochromocytoma

Answer 13

genetic

extra adrenal chromaffin tissue which has failed to involute after birth

Question 14

signs and symptoms of pheochromocytoma

Answer 14

tachycardia, HT, orthostatic HT, palpitations, anxiety, diaphoresis, headaches, pallor, weight loss, hyperglycaemia

Question 15

treatment of pheochromocytoma

Answer 15

removal of tumour
adrenalectomy
prior to surgery - admin of irreversible alpha adrenoceptor blocker and salt loading to reduce risk of profound hypotension due to volume depletion

Question 16

Adrenal insufficiency

Answer 16

hyposecretion of adrenal steroids - glucocorticoids, mineralocorticoids, androgens

Question 17

primary causes of adrenal insufficiency

Answer 17

autoimmune adrenalitis - destruction of adrenal cortex, tuberculosis, adrenal dysgenesis, impaired steroidogensis, some medications, sepsis, bleeding in into adrenal glands, idiopathic

Question 18

Secondary causes of adrenal insufficiency

Answer 18

impairment of pituitary gland or hypothalamus, exogenous steroid use, pituitary adenoma

Question 19

Tertiary causes of adrenal insufficiency

Answer 19

due to hypothalamic disease and decrease in corticotropin releasing hormone (CRH)

Question 20

Addison’s disease

Answer 20

hyposecretion of cortisol and possibly aldosterone

caused by autoimmune destruction of adrenal glands

Question 21

signs and symptoms of addison’s disease

Answer 21

fatigue, HT, muscle weakness, weight loss, fever, nausea and vomiting, headache, diaphoresis, changes in mood, hyperpigmentation of skin

Question 22

Addisonian Crisis/adrenal crisis

Answer 22

collection of symptoms indicaating severe adrenal insufficiency
may arise as a result of untreated Addison’s disease, aute process affecting adrenal function

Question 23

signs and symptoms of Addisonian Crisis

Answer 23

sudden pain in legs, lower back or abdo 
severe vomiting and diarrheoa = dehydration 
HT
syncope
hypoglycaemia
hypokalaemia
hypercalcaemia
severe lethargy
slurred speech
seizure
fever

Question 24

Addison’s disease treatment (chronic)

Answer 24

HRT, pts advised to carry syringe of injectable cortisol for emergency admin if required

Question 25

Addison’s disease treatment (crisis)

Answer 25

IV glucocorticoid admin, IV saline and IV dextrose, vasopressor therpapy if fluid admin does not work, identification and treatment of underlying factor