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endocrine > Adrenal Disorders > Flashcards

Adrenal Disorders Flashcards

1
Q

This deck covers the main adrenal disorders:

A
  • Cushing’s Syndrome
  • Addison’s Disease
  • Conn’s Syndrome
  • Pheochromocytoma
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2
Q

What is Addison’s Disease also known as?

A

Primary Adrenal Insufficiency

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3
Q

What is Addison’s Disease?

A

Insufficiency in adrenal cortex causing insufficient glucocorticoids and mineralocorticoids

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4
Q

What causes Addison’s?

A
  • Adrenal Autoantibodies in 70% of cases e.g. from TB
  • Associated with other autoimmune conditions e.g. Diabetes, thyroid disease, premature ovarian failure
  • Metastatic carcinoma
  • Water Friderichsen Syndrome- sudden increase in BP causes vessels to rupture causing sudden blood rush into adrenal cortex leading to Ischemia
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5
Q

How does Addison’s Present?

A

Due to Low levels of aldosterone:

  • Salt Craving
  • Postural Symptoms
  • N&V + Diarrhoea

Due to low levels of glucorticoid:

  • Skin pigmentation or vitiligo (loss of pigment)
  • Unexplained hypoglycaemia
  • Weakness, confusion during stress

Due to low levels of sex hormones:

  • Low libido in women
  • Reduced axillary and pubic hair
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6
Q

What tests do you do if you suspect Addison’s?

A
  • Routine bloods
  • Random Cortisol
  • Synacthen Test
  • Plasma ACTH
  • Adrenal Auto-antibodies
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7
Q

What does a random cortisol test tell you about addison’s?

A

ITs the first test you do

If they’re cortisol is >700nmol/l then it’s not Addison’s

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8
Q

What does a synacthen test tell you about Addison’s?

A

Give ACTH to see how muhc their cortisol goes up

In addison’s they should produce very little cortisol

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9
Q

Why test plasma ACTH in Addison’s?

A

If its elevated it confirms Primary Adrenal Insufficiency.

If its suppressed however the source is secondary

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10
Q

How do you treat Addison’s disease?

A

Glucocorticoid replacement e.g. Hydrocortisone, Dexamethasone , Predinosole
Mineralocorticoid replacement e.g. Fludrocortisone- has similar shape to mineralocorticoids so binds to the same receptors as them

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11
Q

What do you have to think about when people are Exogenous steroid dependant?

A

During stressfull stimuli they need an increased dose, as their own production if suppressed.

Double dose on minor illness
IV hydrocortisone on major illness, tapered off at 50% a day

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12
Q

What would indicate autoimmune addison’s?

A

Other autoimmune conditions like:

  • Type 1 DM
  • Thyroid disease
  • Premature ovarian failure
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13
Q

How does Cushing’s Disease present?

A

High value:

  • Skin Atrophy
  • Pupura of the skin- bruises
  • Proximal myopathy
  • Osteoporosis
  • Interrupted growth in children

Intermediate value:

  • Stretch marks/striae
  • Oedema
  • Facial mooning/ Hirtusism (presence of XS hair where usually there is no hair)

Non-specific

  • Central Obesity with thin arms and legs
  • Hypertension
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14
Q

Types of Cushing’s?

A

ACTH dependant

  • Pituitary Tumour - 75% (cushings disease)
  • Extopic ACTH - 5% (lung cancer)

ACTH independant:

  • Adrenal adenoma or carcinoma -20%
  • CCS therapy
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15
Q

How do you investigate suspected Cushing’s disease?

A

Screen with overnight dex test or 24 hour urine cortisol

Confirm with 24 hour urine cortisol repear

Paired morning/midnight cortisol/ACTH test to check ACTH dependancy

If ACTH dependant do a High dose Dex test to check pituitary vs ectopic

Localise with MRI/CT/CT chest as appropriate

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16
Q

What is Conn’s Syndrome?

A

An aldosterone secreting tumour in the adrenal cortex

I.e. Primary Hyperaldosteronism

17
Q

Whats the presentation of Conn’s Syndrome?

A

Hypertension with Hypokalemia

18
Q

TEsts for Conn’s Syndrome?

A

If you see hypertension & hypokalemia:

  • Plasma aldosterone/renin ratio.
  • > 20 & a raised aldosterone indicates Conn’s syndrome

Follow up with a 24hr urine aldosterone to confirm

Then CT the adrenal glands

19
Q

What is a pheochromocytoma?

A

A tumour of the adrenal medulla that secretes excess catecholamines

20
Q

How does pheochromocytoma present?

A

Hypertension along with paroxysmal attacks of:

  • Headaches
  • Sweat
  • Palpitations
  • Tremor
  • Pallor
  • Anxiety/fear
21
Q

How do you investigate a pheochromocytoma?

A

patient with High BP & paroxysmal adrenaline attacks

24 hour urine total catecholamines

Followed by adrenal MRI/CT

22
Q

How do you manage pheochromocytoma?

A

Surgically

23
Q

What is Addisonian crisis

A

-High functional reserve of adrenal gland- small amount can carry out big function
Usually symptoms present after about 90% of the gland has been destroyed
-Symptoms ignored until major stressor such as injury, surgery and infection
-In this instance the body will require more Aldosterone and Cortisol- ADDISONS CRISIS
-Occurs when the zona glomerulosa and Fasciculata are almost completely destroyed

24
Q

Symptoms characteristic of an addisonian crisis

A
  • Pain in Back/abdomen
  • Vomiting and Diarrhoea
  • Dehydration
  • Low BP
  • Loss of Consciousness
  • Death
25
Q

How to treat Cushing’s

A
  • If exogenous medications- STOP THEM GRADUALLY- adrenal crisis if stopped too quickly
  • Pituitary adenoma- surgical excision
  • Adrenal steroid inhibitors
26
Q

Difference between primary and secondary hyperaldosterism

A 
Primary
Aldosterone inhibits Renin   
So high Plasma aldosterone 
Low Plasma Renin 
PA/PR >20

Secondary
Too much renin from kidneys
So high PR and high PA
PA/PR<20

27
Q

What are the types of pheochromocytoma?

A

10% extra adrenal
10% bilateral
10% are malignant
10% are non-functioning

28
Q

What is the aetiology of pheochromocytoma?

A

30% chance of inherited genes:
MEN
Von Hi[[el Landau disease
Familial paragangliomas

29
Q

What are the primary and secondary causes for Conn’s

A

Primary:

  • Adenoma of the adrenal gland
  • Bilateral hyperplasia

Secondary:

  • renal failure
  • use of diuretics
  • renin secreting tumours
  • malignant hypertension
30
Q

why do you get skin pigmentation in Addisons?

A

Due to high amounts of circulating ACTH

This binds to melanin receptors and causes more melanin to be produced- especially over the buccal mucosa.

endocrine (25 decks)

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