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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
what other autoimmune diseases is addisons associated with?
T1DM autoimmune thyroid disease pernicious anaemia
26
clinical presentation of addisons?
``` anorexia weight loss dizziness hypotension abdo pain vomiting diarrhoea skin pigmentation ```
27
``` what effect does addisons have on: Na K glucose ACTH ```
Na low K high glucose low ACTH v high
28
normal baseline cortisol?
250nmol/l
29
normal post ACTH cortisol?
>550
30
investigations for addisons?
blood test synacthen test autoantibodies test for other autoimmune conditions
31
why is ACTH so high in addisons?
no cortisol is made so ACTH upregulates itself
32
why are some addisons patients very tanned?
excess ACTH will break down into melanotonin
33
what effect does addisons have on renin and aldosterone levels?
aldosterone low | renin high
34
should you give hydrocortisone immediately to a patient with suspected addisons?
yes if severe
35
dose and timing of hydrocortisone for addisons?
15-20mg in divided doses, give no later than 6pm bc insomnia
36
1st and 2nd line treatments for addisons?
1. hydrocortisone | 2. fludrocortisone
37
what is hydrocortisone?
cortisol replacement
38
what is fludrocortisone?
aldosterone replacement
39
why don't you get tanned in secondary adrenal insufficiency?
ACTH isn't increased
40
what effect does secondary adrenal sufficiency have on aldosterone?
nothing
41
what group is cushings most common in?
women aged 20-40
42
most common cause of cushings?
pituitary adenoma
43
what would you suspect in a patient with easy bruising, multiple recent fractures and stretch marks?
cushings
44
most common cause of secondary adrenal insufficiency?
exogenous steroid use
45
is a pituitary adenoma an ACTH dependent or independent cause of cushings?
dependent
46
what happens if the patient fails the dexamethasone test?
they need to undergo special tests
47
when would you get a false positive from a dexamethasone suppression test?
depression stress obesity acute illness
48
what effect do steroids have on ACTH?
reduces its production
49
what is essential hypertension?
hypertension with no cause
50
what does hypertension and hypokalaemia equate to?
primary aldosteronism
51
what is primary aldosteronism?
autonomous aldosterone production independent of its regulators
52
what effect does aldosterone have on cytokines?
increases them
53
what heart pathology is most commonly a result of high aldosterone?
LVH
54
commonest secondary cause of hypertension?
primary aldosteronism
55
clinical features of primary aldosteronism?
hypokalaemia | alkalosis
56
1st line investigation for primary aldosteronism
measure aldosterone to renin ratio
57
2nd line investigation for primary aldosteronism and how it is diagnosed?
if ARR raised do saline suppression test; if plasma aldosterone isn't suppressed by 50% of 2l of normal saline = PA
58
how would you confirm the subtype of primary aldosteronism?
adrenal CT
59
gold standard scan for an aldosterone secreting adenoma?
PET CT
60
when would you do surgery for primary aldosteronism?
if there's an adrenal adenoma
61
how could surgery manage primary aldosteronism?
unilateral laparoscopic adrenalectomy
62
how is primary aldosteronism managed medically?
with mineralocorticoid receptor antagonists eg spirinolactone
63
commonest deficiency causing congenital adrenal hyperplasia?
21a hydroxylase deficiency
64
presentation of CAH?
``` salt wasting failure to thrive nausea/vomiting ambiguous genitalia in girls acne ```
65
how is CAH diagnosed?
basal 17-OH progesterone
66
why do girls get ambiguous genitalia in CAH?
excess progesterone leads to excess testosterone
67
what would you suspect in a young woman with dyspnoea, high BP, tachy and poor LV function and why?
phaeochromocytoma because of increased catecholamine secretion
68
investigations for phaeochromocytoma?
MIBG scan CT MRI abdo
69
``` which of these symptoms is not associated with phaeochromocytoma?: hypertension postural hypertension paroxysmal sweating bradycardia ```
bradycardia
70
differentials for phaeochromocytoma?
angina anxiety menopause arrhythmia
71
classical triad of phaeochromocytoma?
hypertension headache sweating
72
complications of phaeochromocytoma?
``` LVF myocardial necrosis stroke shock paralytic ileus of bowel ```
73
do phaeochromocytomas cause hyperglycaemia or hypoglycaemia?
hyper

2 Endocrine (35 decks)

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