Adrenal Disorders Flashcards
Describe the arrangement of the adrenal veins.
The right adrenal vein drains directly into the IVC
The left adrenal vein drains to the left renal vein and then to the IVC
Describe the passage of blood through the adrenal gland.
The blood flows through the adrenal arteries and arterioles in the cortex where it picks up all the adrenal hormones and then it drains into a single CENTRAL VEIN.
What are the three layers of the adrenal gland from the outside to the inside?
Zona Glomerulosa (aldosterone) Zona Fasciculata (cortisol) Zona Reticularis (doesn't do much - evolutionary remnant) Adrenal Medulla (catecholamines)
What is the precursor for ACTH?
Proopiomelanocortin – POMC
Why does an increase in ACTH cause hyperpigementation of the skin?
POMC is broken down to ACTH and Melanocyte Stimulating Hormone (MCH) which stimulates the pigmentation of the skin.
What is Addison’s Disease?
Primary adrenal failure
What can Addison’s Disease be caused by? State the most common cause in the UK and the most common cause worldwide.
UK - autoimmune disease - the immune system wipes out the adrenal cortex
Worldwide - tuberculosis
State some clinical features of Addison’s Disease.
Pigmentation of the skin Weight loss Hypotension Muscular weakness Autoimmune vitiligo
What are the steps that need to be taken if a patient is experiencing an Addisonian Crisis?
Rehydrate with saline
Dextrose tablets to counteract the hypoglycaemia due to lack of cortisol
Hydrocortisone or another glucocorticoid medication
What are the consequences of excess cortisol?
Impaired glucose tolerance (due to chronic elevation of blood glucose) Interscapular fat pad Moon face Hypertension Striae Thin skin and easy bruising Proximal myopathy
State four causes of Cushing’s Syndrome.
Oral steroid drugs
Pituitary tumour causing overproduction of ACTH
Ectopic ACTH (some lung cancer cells can produce ACTH)
Adrenal adenoma or carcinoma
What is the difference between Cushing’s Syndrome and Cushing’s Disease?
Cushing’s Syndrome is a constellation of symptoms
Cushing’s Disease = when the cause of Cushing’s Syndrome is known as being a pituitary adenoma
What is Conn’s Syndrome?
Aldosterone producing adenoma
Leads to hypertension, oedema and hypokalaemia
