Adrenal Disorders Flashcards
Adrenal cortex produces
corticosteroids from cholesterol: mineraocorticoids (aldosterone), glucocorticoids (cortisol), gonadocorticoids (androgens)
adrenal medulla produces
catecholamines (adrenaline)
Cushings Syndrome
chronic hypercortisolism (prolonged exposure to cortisol) Abnormally high circulating level of glucocorticosteroid hormones
Causes of Cushing’s Syndrome
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
Signs and symptoms of Cushing’s SYndrome
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)
Cushingoid
cataracts, ulcers, hypertension, infection, nectrosis, glycosuria, osteroporosis, diabetes
Treatment of Cushings syndrome
ceasing and corticosteroid meds
removal of any adrenal adenoma
bilateral adrenalectomy
admin of drugs which inhibit cortisol secretion
Hyperadosteronism
hypersecretion of aldosterone by adrenal glands
results in hypokalaemia (lowered levels of potassium) and alkalosis via increase H+ ion excretion
Primary and secondary acuses of hyperaldosteronism
Primary - conn’s syndrome (adrenal Adenoma), congenital adrenal hyperplasia
secondary - overactivity of the renin-angiotensin-aldosterone system, juxtaglomerular tumour, renal artery stenosis
Signs and symptoms of hyperaldosteronism
hypertension, fatigue, headache, hypokalaemia, hypomagnesaemia, muscle spasms and weakness, polyuria, polydipsia, metabolic acidosis
treatment of hyperaldosteronism
removal of the adenoma if possible
spironolactone (potassium sparing diuretic- aldosterone antagonist)
Pheochromocytoma
tumour of the adrenal medulla resulting in a hypersecretion of catecholamines
causes of pheochromocytoma
genetic
extra adrenal chromaffin tissue which has failed to involute after birth
signs and symptoms of pheochromocytoma
tachycardia, HT, orthostatic HT, palpitations, anxiety, diaphoresis, headaches, pallor, weight loss, hyperglycaemia
treatment of pheochromocytoma
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
Adrenal insufficiency
hyposecretion of adrenal steroids - glucocorticoids, mineralocorticoids, androgens
primary causes of adrenal insufficiency
autoimmune adrenalitis - destruction of adrenal cortex, tuberculosis, adrenal dysgenesis, impaired steroidogensis, some medications, sepsis, bleeding in into adrenal glands, idiopathic
Secondary causes of adrenal insufficiency
impairment of pituitary gland or hypothalamus, exogenous steroid use, pituitary adenoma
Tertiary causes of adrenal insufficiency
due to hypothalamic disease and decrease in corticotropin releasing hormone (CRH)
Addison’s disease
hyposecretion of cortisol and possibly aldosterone
caused by autoimmune destruction of adrenal glands
signs and symptoms of addison’s disease
fatigue, HT, muscle weakness, weight loss, fever, nausea and vomiting, headache, diaphoresis, changes in mood, hyperpigmentation of skin
Addisonian Crisis/adrenal crisis
collection of symptoms indicaating severe adrenal insufficiency
may arise as a result of untreated Addison’s disease, aute process affecting adrenal function
signs and symptoms of Addisonian Crisis
sudden pain in legs, lower back or abdo severe vomiting and diarrheoa = dehydration HT syncope hypoglycaemia hypokalaemia hypercalcaemia severe lethargy slurred speech seizure fever
Addison’s disease treatment (chronic)
HRT, pts advised to carry syringe of injectable cortisol for emergency admin if required
Addison’s disease treatment (crisis)
IV glucocorticoid admin, IV saline and IV dextrose, vasopressor therpapy if fluid admin does not work, identification and treatment of underlying factor
