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2 Endocrine > Adrenal Disorders > Flashcards

Adrenal Disorders Flashcards

1
Q

name the adrenal layers from superficial to deep

A

capsule
cortex
medulla

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2
Q

normal adrenal gland weight?

A

4g

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3
Q

name the zones of the adrenal gland from superficial to deep

A

zona glomerulosa
zona fasciculata
zona reticularis

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4
Q

what hormone regulates the zona fasciculata?

A

ACTH

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5
Q

what hormone regulates the zona reticularis?

A

ACTH

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6
Q

where are mineralocorticoids synthesised within the adrenal gland?

A

zona glomerulosa

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7
Q

where are glucocorticoids synthesised within the adrenal gland?

A

zona fasciculata

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8
Q

what are the zones of the adrenal gland located in?

A

cortex

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9
Q

what hormones are located in the zona reticularis?

A

adrenal androgens eg DHEA

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10
Q

where in the adrenal gland are catecholamines made?

A

medulla

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11
Q

what 2 things regulate aldosterone?

A

RAAS

plasma potassium

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12
Q

when is the hypothalamus stimulated to make CRH? what is the end result of this?

A

illness
stress
early morning

= cortisol made

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13
Q

when is RAAS activated?

A

when BP is low

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14
Q

what does angiotensin 2 do?

A

causes vasoconstriction and aldosterone production

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15
Q

name the 6 classes of steroid receptor

A 
glucocorticoid
mineralocorticoid
progestin
oestrogen
androgen
vitamin D
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16
Q

what effect does cortisol have on libido?

A

decreases it

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17
Q

how does cortisol accelerate osteoporosis?

A

decreases serum Ca

decreases collagen formation

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18
Q

does cortisol play a part in immune function?

A

no, it stops inflammation

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19
Q

where are mineralocorticosteroid receptors located?

A

kidneys
salivary glands
gut
sweat glands

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20
Q

what effect do mineralocorticoids have on Na and K?

A

increases K excretion

increases Na reabsorption

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21
Q

what adrenal disorder is commonly diagnosed as an eating disorder and why?

A

addisons; both cause fast weight loss, loss of periods and fatigue

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22
Q

causes of primary adrenal insufficiency?

A

Addison’s
congenital adrenal hyperplasia
adrenal TB
adrenal malignancy

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23
Q

causes of secondary adrenal insufficiency

A

lack of ACTH production
excess steroids
pituitary/hypothalamic disorder

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24
Q

why are autoantibodies involved n addisons?

A

it is an autoimmune condition

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25
Q

what other autoimmune diseases is addisons associated with?

A

T1DM
autoimmune thyroid disease
pernicious anaemia

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26
Q

clinical presentation of addisons?

A 
anorexia
weight loss
dizziness
hypotension
abdo pain
vomiting
diarrhoea
skin pigmentation
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27
Q 
what effect does addisons have on:
Na
K
glucose
ACTH
A

Na low
K high
glucose low
ACTH v high

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28
Q

normal baseline cortisol?

A

250nmol/l

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29
Q

normal post ACTH cortisol?

A

> 550

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30
Q

investigations for addisons?

A

blood test
synacthen test
autoantibodies
test for other autoimmune conditions

31
Q

why is ACTH so high in addisons?

A

no cortisol is made so ACTH upregulates itself

32
Q

why are some addisons patients very tanned?

A

excess ACTH will break down into melanotonin

33
Q

what effect does addisons have on renin and aldosterone levels?

A

aldosterone low

renin high

34
Q

should you give hydrocortisone immediately to a patient with suspected addisons?

A

yes if severe

35
Q

dose and timing of hydrocortisone for addisons?

A

15-20mg in divided doses, give no later than 6pm bc insomnia

36
Q

1st and 2nd line treatments for addisons?

A
  1. hydrocortisone

2. fludrocortisone

37
Q

what is hydrocortisone?

A

cortisol replacement

38
Q

what is fludrocortisone?

A

aldosterone replacement

39
Q

why don’t you get tanned in secondary adrenal insufficiency?

A

ACTH isn’t increased

40
Q

what effect does secondary adrenal sufficiency have on aldosterone?

A

nothing

41
Q

what group is cushings most common in?

A

women aged 20-40

42
Q

most common cause of cushings?

A

pituitary adenoma

43
Q

what would you suspect in a patient with easy bruising, multiple recent fractures and stretch marks?

A

cushings

44
Q

most common cause of secondary adrenal insufficiency?

A

exogenous steroid use

45
Q

is a pituitary adenoma an ACTH dependent or independent cause of cushings?

A

dependent

46
Q

what happens if the patient fails the dexamethasone test?

A

they need to undergo special tests

47
Q

when would you get a false positive from a dexamethasone suppression test?

A

depression
stress
obesity
acute illness

48
Q

what effect do steroids have on ACTH?

A

reduces its production

49
Q

what is essential hypertension?

A

hypertension with no cause

50
Q

what does hypertension and hypokalaemia equate to?

A

primary aldosteronism

51
Q

what is primary aldosteronism?

A

autonomous aldosterone production independent of its regulators

52
Q

what effect does aldosterone have on cytokines?

A

increases them

53
Q

what heart pathology is most commonly a result of high aldosterone?

A

LVH

54
Q

commonest secondary cause of hypertension?

A

primary aldosteronism

55
Q

clinical features of primary aldosteronism?

A

hypokalaemia

alkalosis

56
Q

1st line investigation for primary aldosteronism

A

measure aldosterone to renin ratio

57
Q

2nd line investigation for primary aldosteronism and how it is diagnosed?

A

if ARR raised do saline suppression test; if plasma aldosterone isn’t suppressed by 50% of 2l of normal saline = PA

58
Q

how would you confirm the subtype of primary aldosteronism?

A

adrenal CT

59
Q

gold standard scan for an aldosterone secreting adenoma?

A

PET CT

60
Q

when would you do surgery for primary aldosteronism?

A

if there’s an adrenal adenoma

61
Q

how could surgery manage primary aldosteronism?

A

unilateral laparoscopic adrenalectomy

62
Q

how is primary aldosteronism managed medically?

A

with mineralocorticoid receptor antagonists eg spirinolactone

63
Q

commonest deficiency causing congenital adrenal hyperplasia?

A

21a hydroxylase deficiency

64
Q

presentation of CAH?

A 
salt wasting
failure to thrive
nausea/vomiting
ambiguous genitalia in girls
acne
65
Q

how is CAH diagnosed?

A

basal 17-OH progesterone

66
Q

why do girls get ambiguous genitalia in CAH?

A

excess progesterone leads to excess testosterone

67
Q

what would you suspect in a young woman with dyspnoea, high BP, tachy and poor LV function and why?

A

phaeochromocytoma because of increased catecholamine secretion

68
Q

investigations for phaeochromocytoma?

A

MIBG scan
CT
MRI abdo

69
Q 
which of these symptoms is not associated with phaeochromocytoma?:
hypertension
postural hypertension
paroxysmal sweating
bradycardia
A

bradycardia

70
Q

differentials for phaeochromocytoma?

A

angina
anxiety
menopause
arrhythmia

71
Q

classical triad of phaeochromocytoma?

A

hypertension
headache
sweating

72
Q

complications of phaeochromocytoma?

A 
LVF
myocardial necrosis
stroke
shock
paralytic ileus of bowel
73
Q

do phaeochromocytomas cause hyperglycaemia or hypoglycaemia?

A

hyper

2 Endocrine (35 decks)

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