Adrenal disorders Flashcards

1
Q

name a condition that affects the production of each of the adrenal hormones.

A
aldosterone - Conn's 
cortisol - cushings (hyperfunction)
cortisol - addisons (hypofunction)
sex hormones - congenital adrenal hyperplasia 
epinephrine - phaeochromocytoma
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2
Q

what is the cause of Conn’s syndrome?

A

over production of aldosterone caused by a tumour of the pituitary gland

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3
Q

what is the presentation of a paeochromocytoma?

A

episodic / paroxysmal attacks;

  • palpitations
  • sweating
  • pallor
  • headache
  • tremor
  • anxiety / fear
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4
Q

what is the most common cause of addison’s disease?

A

autoimmune destruction of the adrenal glands

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5
Q

what is the presentation of Addison’s disease?

A
fatigue
weakness
anorexia / weight loss
salt craving 
unexplained vomiting or diarrhoea 
postural symptoms
hypotension 
skin pigmentation / vitiligo
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6
Q

what is commonly associated with Addisons disease?

A

other autoimmune conditions because if you have one your are likely to have another such as;

  • type 1 diabetes
  • thyroid disease (hashimotos)
  • premature ovarian failure
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7
Q

when carrying out a random cortisol if there is suspicion of addisons disease, what values would suggest addisons or not?

A

> 700 nmol/L = not addisons

< 700 nmol/L (adrenal status still uncertain but may be addisons)

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8
Q

what is the name of the confirmatory test for diagnosing addisons?

A

Synacthen test

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9
Q

what is the treatment for addisons?

A

hydrocortisone therapy 20-30mg
- given in divided dose i.e. 20mg in the morning and 10mg at dinner time

prednisolone 7.5mg
dexamethasone 0.75mg
mineralocorticoid therapy - flurocortisone 50-300mg (resolve the hypotension & hyponatraemia)

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10
Q

why can addison’s cause hypotension and salt cravings?

A

with cortisol insufficiency from the hypofunctioning adrenal gland , it can also cause hypo secretion of mineralocorticoids - aldosterone

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11
Q

what are the causes of cushings syndrome?

A

pituitary tumour
actopic ACTH secretion from lung carcinoma
adrenal tumour
corticosteroid therapy

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12
Q

what is the presentation of cushings syndrome?

A
central obesity
muscle atrophy 
proximal weakness
pink striae 
moon face 
hypertension
hyperglycaemia - diabetes mellitus
poor wound healing 
osteoporosis 
hirsutism 
amenorrhoea / galactorrhoea 
acne 
personality changes / depression
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13
Q

how would you screen for curhsings syndrome?

A

24 hour urine free cortisol

1mg overnight dexamethasone test

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14
Q

what results in the tests of low dose and high dose dexamthasone would be suggestive of cushings disease (tumour in the pituitary)?

A

with a low dose dexamthasone the cortisol levels are still high - doesnt respond
but it responds to high levels as the cortisol levels will derease

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15
Q

what is the plasma renin activity (PRA) and plasma aldosterone concentration (PAC) like in someone with conn’s syndrome?

A

plasma renin decreased

plasma aldosterone raised

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16
Q

if there is increased plasma renin activity and increased plasma aldosterone concentration, what would you investigate next to come to a diagnosis?

A

increased PRA & PAC = secondary hyperaldosteronism

investigate for causes such as renovascular hypertension, coarctation of aorta, diuretic use, malignant hypertension etc
(causes of secondary hypertension that isnt caused by an endocrine condition)

17
Q

what could be the cause of a decreased plasma renin activity and a decreased plasma aldosterone concentraion?

A

congenital adrenal hyperplasia

18
Q

what tests would you carry out to establish the source of the over production of aldosterone ? (after PRA and PAC has been carried out)

A

CT scan of adrenal glands
upright posture test
adrenal venous sampling
24 hour urine aldosterone and sodium

19
Q

why is a phaeochromocytoma termed as the 10% tumour?

A
10% malignancy
10% extra adrenal
10% multiple
10% hyperpglycaemia 
but 30% has an inherited origin
20
Q

what are the first 2 tests you carry out if your suspect adrenal insufficiency?

A
plasma cortisol ( < 700nmol/L)
synACTHen test ( < 500 mmol/L)
21
Q

how do you differentiate whether the low cortisol is due to primary adrenal insufficiency or secondary?

A

plasma ACTH levels
low ACTH = secondary
high ACTH = primary

22
Q

what tests would you carry out to investigate the cause of primary adrenal insufficiency?

A

MRI adrenal glands - tumour, infarction, haemorrhage, infection
serum antibodies- Addison’s, anti 21 hydroxylase, other autoimmune conditions
screen for rarer causes such as HIV, TB, secondary malignancy

23
Q

how long is a patient on steroid therapy for it to suppress their pituitary adrenal axis?

A

> 7.5mg prednisolone daily for 3 weeks

24
Q

what adjustments do people on steroid therapy (due to adrenal insufficiency) have to make if they have vomiting/diarrhoea?

A

IM injection of hydrocortisone

not allowed to do it themselves

25
what adjustments do patients on steroid therapy (due to adrenal insufficiency) have to make if they get the flu / minor illness?
double their dose of steroids
26
what can be the cause of adrenal insufficnecy in women if its not addisons?
adrenal infiltration, infarction, haemorrhage or infection
27
what can be the cause of adrenal insufficiency in males if its not addisons?
adrenal infiltration, infarction, haemorrhage, or infection | adrenoleucodystrophy
28
what does the presence of very long chain fatty acids (VLCFA) in males with adrenal insuficiency indicate?
adrenoleukodystrophy
29
what are the rare causes of addison's disease?
``` malignancy i.e. breast, melanoma, lung infiltration infection i.e. TB, HIV infarction iatrogenic 21 hydroxyls insufficiency ```