Adrenal Disorders Flashcards

1
Q

What does the adrenal cortex produce?

A
  1. Glucocorticoids (cortisol) - affect carbohydrate, lipid and protein metabolism
  2. Mineralocorticoids (aldosterone) - control sodium and potassium levels
  3. Androgens - sex hormones
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2
Q

What is Cushing’s syndrome?

A

The clinical state produced by chronic exposure to high cortisol levels

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3
Q

What are the clinical features of cushing’s syndrome?

A

Round plethoric face, acne, skin thinning, bruising, hirsutism, central obesity, buffalo hump, proximal muscle weakness, mood disturbances, hypokalemia

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4
Q

What causes cushings syndrome?

A

Endogenous:
- ACTH dependent) - increased ACTH due to cushings disease (pituitary adenoma) or other cancer
- ACTH independent - adrenal adenoma, nodular hyperplasia
Exogenous:
- Steroid use

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5
Q

What is the first line investigation of Cushing’s?

A

24 hour urinary free cortisol excretion AND
Overnight dexamethasone suppression test

If tumour is suspected, do CT/MRI to investigate

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6
Q

What causes hypoadrenalism?

A

Primary - autoimmune (addisons), TB, HIV

Secondary - Prolonged exogenous steroids, pituitary lesions

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7
Q

What is Addison’s disease?

A

Adrenal insufficiency due to autoimmune destruction of the adrenal gland

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8
Q

What are the symptoms and signs of Addison’s disease?

A

Lean, TANNED, tired, tearful, dizzy, faints, mood disorders - very non-specific

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9
Q

How can hypoaldrenalism be investigated?

A

Short synacthen test:

  • Do baseline bloods for cortisol and acth
  • Give 250 mcgrams synacthen IM (corticotrophic agent)
  • Measure cortisol at 0, 30, 60 minutes

Those with hypoadrenalism will have only small rises in cortisol

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10
Q

How can hypoaldrenalism be treated?

A

Glucocorticoid replacement (hydrocortisone, prednisolone, dexamethasone)

Mineralocorticoid replacement (fludrocortisone) - NB this isn’t necessary in secondary hypoadrenalism as the adrenal cortex is still intact)

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11
Q

When should steroids be given?

A

Earlier in the day as they can cause insomnia

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12
Q

What is an Addisonian crisis?

A

Shock, drowsiness, N&V, low BP, severe headache, hyperkalemia, hyponatremia, hypoglycaemia etc - precipitated by severe physical shock, infection, infarction or dehydration

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13
Q

How should an Addisonian crisis be managed?

A

IV fluid bolus

IV hydrocortisone STAT

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14
Q

What is metyrapone?

A

Treatment given in cushion’s syndrome that suppresses steroid biosynthesis

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15
Q

Describe the system that leads to androgen and glucocorticoid production

A
  1. Hypothalamus secretes corticotrophin-releasing factor
  2. Pituitary secretes ACTH
  3. Adrenal cortex produces androgens/glucocorticoids

This is a negative feedback system

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16
Q

What are the symptoms of hyperaldosteronism?

A

Weakness, cramps, paraesthesia, polyruia, polydipsia, hypokalaemia

17
Q

What causes hyperaldosteronism

A

Primary - adnema (Conn’s syndrome), carcinoma

Secondary - renal artery stenosis, hepatic failure, hypertension (causes high renin from low renal perfusion)

18
Q

How does renin work?

A

Juxtaglomerular cells in the kidney secrete renin when there is low renal perfusion, in order to increase blood pressure.

19
Q

How is hyperaldosteronism treated?

A

Spironolactone usually