Adrenal disorders Flashcards
What is the name of the disease which is caused by Adrenal Failure?
Addison’s disease
What is the name of the disease caused by excess cortisol production?
Cushing’s Syndrome
Draw a simple diagram showing the anatomy of the Adrenal glands?
Include the kidneys, liver, spleen, Aorta, IVC, the adrenal veins and arteries?
What is the difference between the left adrenal vein and the right adrenal vein?
- Left adrenal vein drains into renal vein
- Right adrenal vein drains into IVC
•Both adrenals have many arteries but only ……. vein
•Both adrenals have many arteries but only one vein
Left adrenal vein drains into the………… ………. and then into the ………….. ………. …………
Right adrenal vein drains directly into the ………………. …………… ………………..
Both adrenal glands have many arteries but ONLY ……… CENTRAL VEIN
Left adrenal vein drains into the renal vein and then into the inferior vena cava
Right adrenal vein drains directly into the Inferior vena cava
Both adrenal glands have many arteries but ONLY ONE CENTRAL VEIN
What organ is at risk with an left adrenalectomy?
What precautions are taken before a left adrenalectomy- it is linked with that organ?
- Spleen at risk with left adrenalectomy
- therefore immunise with HIB (haemophilus influenzae (B)) and pneumovax before elective left adrenalectomy
The image below is looking from behind- notice the spline
Draw a simple diagram showing the different types of tissue in an adrenal gland?
List all the zones of the adrenal gland and state what hormones they produce?
Draw the hypothalamus- pituitary- adrenal axis?
State the adrenal gland secretions and their precursor molecules
- Cortisol
- aldosterone
- sex steroids
- Precursor : cholesterol
List the 3 main types of hormones?
THREE main groups of hormones:
Peptides (e.g. prolactin, somatotrophin, ACTH)
Steroids (e.g. testosterone, cortisol)
Amines (e.g. adrenaline)
The enzymes present in a cell control the synthesis of different substances
Enzymes that act on this cholesterol body are labelled by the number of the carbon that they affect
What is the precursor molecule for ACTH?
POMC = pro-opio-melanocortin
When POMC is cleaved what is produced?
What changes happens to a patient when they have Pathologically high levels of ACTH- the answer is linked with POMC and has nothing to do with excess cortisol?
- POMC is a large precursor protein that is cleaved to form a number of smaller peptides, including ACTH, MSH and endorphins
- Thus people who have pathologically high levels of ACTH may become tanned
MSH = melanocyte-stimulating hormone
What is the most common cause of Addison’s disease in the UK?
What is the most common cause of Addison’s disease worldwide?
- Primary adrenal failure
- autoimmune disease where the immune system decides to wipe out the adrenal cortex (UK)
- tuberculosis of the adrenal glands (commonest cause worldwide)
Why does primary adrenal failure cause hyperpigmentation?
Pituitary starts secreting lots of ACTH and hence MSH
REMEMBER- PRIMARY ADRENAL FAILURE MEANS NO ALDOSTERONE AS WELL
Why is low blood pressure a symptom of Addison’s disease?
•no cortisol or aldosterone, so low blood pressure
Autoimmune vitiligo may coexist with Addison’s disease
How would you treat an addison’s crisis?
Here are a list of symptoms for an addison’s crisis?
extreme weakness
mental confusion
dizziness
nausea or abdominal pain
vomiting
fever
a sudden pain in the lower back or legs
a loss of appetite
extremely low blood pressure
chills
skin rashes
sweating
a high heart rate
loss of consciousness
- Rehydrate with normal saline
- Give dextrose to prevent hypoglycaemia which could be due to the glucocorticoid deficiency
- give hydrocortisone or another glucocorticoid
Summary Addison’s
- Cortisol deficiency
- Salt loss
- Low blood pressure
- Eventual death
List 11 Biological actions of excess cortisol?
- Impaired glucose tolerance (diabetes)
- weight gain (increase fat, lose protein)
- thin skin and easy bruising- due to not making protein
- striae (stretch marks)
- proximal myopathy (muscle weakness)
- mental changes (depression)
- Hypertension
- fat redistribution
- moon face
- buffalo hump (interscapular fat pad)
- hirsutism (facial hair) and acne
Cushings Syndrome
Occurs due to an excess of cortisol or other glucocorticoid
List four possible causes of Cushing’s syndrome
- Taking steroids by mouth (common)
- pituitary dependent Cushing’s disease (pituitary adenoma)
- Ectopic ACTH (lung cancer)
- adrenal adenoma or carcinoma
List 6 clinical signs of Cushing’s ?
- Thin skin
- proximal myopathy
- centripetal obesity (lemon on sticks)
- diabetes, hypertension and osteoporosis
- immunosuppression (reactivation of TB)
- moon face
What is the difference between Cushing’s disease and Cushing’s Syndrome?
Cushings syndrome- Any Cause
Cushing’s disease-Where the cause is known to be a pituitary adenoma
Aldosterone producing adenoma
- Conn’s syndrome
- Hypertension (difficult to treat)
- oedema
- low potassium
What are the side effects os steriods?
Same as Cushing’s
- Hypertension
- Diabetes
- Osteoporosis
- reactivation of infection (immunosuppression)
- easy bruising
- poor wound healing, thin skin
