Adrenal Disorders

Question 1

Describe the arrangement of the adrenal veins.

Answer 1

The right adrenal vein drains directly into the IVC The left adrenal vein drains to the left renal vein and then to the IVC

Question 2

Describe the passage of blood through the adrenal gland.

Answer 2

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.

Question 3

What are the three layers of the adrenal gland from the outside to the inside?

Answer 3

Zona Glomerulosa (aldosterone) Zona Fasciculata (cortisol) Zona Reticularis (doesn’t do much - evolutionary remnant) Adrenal Medulla (catecholamines)

Question 4

What is the precursor for ACTH?

Answer 4

Proopiomelanocortin – POMC

Question 5

Why does an increase in ACTH cause hyperpigementation of the skin?

Answer 5

POMC is broken down to ACTH and Melanocyte Stimulating Hormone (MSH) which stimulates the pigmentation of the skin.

Question 6

What is Addison’s Disease?

Answer 6

Primary adrenal failure

Question 7

What can Addison’s Disease be caused by? State the most common cause in the UK and the most common cause worldwide.

Answer 7

UK - autoimmune disease - the immune system wipes out the adrenal cortex Worldwide - tuberculosis

Question 8

State some clinical features of Addison’s Disease.

Answer 8

• Pigmentation of the skin
• Weight loss
• Hypotension
• Muscular weakness
• Autoimmune vitiligo

Question 9

What are the steps that need to be taken if a patient is experiencing an Addisonian Crisis?

Answer 9

Rehydrate with saline Dextrose tablets to counteract the hypoglycaemia due to lack of cortisol Hydrocortisone or another glucocorticoid medication

Question 10

What are the consequences of excess cortisol?

Answer 10

• Impaired glucose tolerance (due to chronic elevation of blood glucose DIABETES)
• Interscapular fat pad
• Moon face Hypertension
• Striae
• Thin skin and easy bruising
• Proximal myopathy
• Hirsutism (facial hair)

Question 11

State four causes of Cushing’s Syndrome.

Answer 11

Oral steroid drugs Pituitary tumour causing overproduction of ACTH Ectopic ACTH (some lung cancer cells can produce ACTH) Adrenal adenoma or carcinoma

Question 12

What is the difference between Cushing’s Syndrome and Cushing’s Disease?

Answer 12

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

Question 13

What is Conn’s Syndrome?

Answer 13

• Tumour of the zona glomerulosa (which produces aldosterone) - ADENOMA
• Aldosterone makes you retain sodium and lose potassium

Symptoms

• hypertension
• oedema
• hypokalaemia
• Metabolic alkalosis

Question 14

Define Cushing’s syndrome

Answer 14

excessive cortisol production