Adrenal Disorders

Question 1

Adrenal failure

Answer 1

Addison’s disease

Question 2

Excess cortisol

Answer 2

Cushing’s syndrome

Question 3

How many central veins do the adrenal glands have?

Answer 3

one central vein despite many arteries

Question 4

What lies next to the left adrenal gland?

Answer 4

spleen
easily damaged during left adrenalectomy (high vasculature and proximity)
patient must be immunised with HIB and pneumovax (against strains of Streptococcus pneumococcus)

Question 5

How are hormones from adrenal gland mobilised?

Answer 5

arteries pass through cortex and pick up hormones made by adrenal gland
these are then delivered to the central vein

Question 6

What are the 3 main hormone groups?

Answer 6

peptides (prolactin, somatotrophin, ACTH)
steroids (testosterone, cortisol)
amines (adrenaline)

Question 7

What determines the product steroid hormones derived from C27 cholesterol?

Answer 7

enzymes present in the target tissue

each zone of adrenal cortex has different enzymes

Question 8

What is the pathway for aldosterone production?

Answer 8

pregnenolone
progesterone (3)

ONLY IN ADRENALS (contain 21-hydroxylase enzyme needes)
11 deoxycorticosterone (21)
corticosterone (11)
aldosterone (18)

Question 9

What is the pathway for cortisol production?

Answer 9

17 OH pregnenolone
progesterone
17 OH progesterone (17)

ONLY IN ADRENALS (contain 17-hydroxyprogesterone enzyme)
11 deoxycortisol (21)
cortisol (11)

Question 10

What is the pathway for oestrogen production?

Answer 10

progesterone
17 OH progesterone
androstenedione
converted further in gonads 
sex steroids
androgens
oestrogens

Question 11

What is POMC?

Answer 11

precursor for ACTH
it is cleaved into smaller peptides (ACTH, MSH and endorphins)
high ACTH also inappropriately tanned (MSH high too)

Question 12

Describe the cause of Addison’s disease

Clinical features

Answer 12

primary adrenal failure

• autoimmune disease destroys adrenal cortex
• tuberculosis of adrenal glands

INCREASE PIGMENTATION - Pituitary secretes excess ACTH to compensate for lack of cortisol so increases MSH
Low blood pressure as adrenals do not make aldosterone/cortisol
Autoimmune vitiligo may coexist
Salt loss
Eventual death

Question 13

What the most common worldwide and UK causes of primary adrenal failure?

Answer 13

worldwide - TB of adrenal glands

UK - autoimmune disease destroys cortex

Question 14

What is the urgent treatment plan for Addisonian crisis?

Answer 14

rehydrate with normal saline
give dextrose to prevent hypoglycaemia which could occur due to glucocorticoid deficiency
give hydrocortisone/glucocorticoid medication

Question 15

What are the biological effects of excess cortisol and cause?

Answer 15

impaired glucose tolerance(diabetes) - increased blood glucose []
weight gain, thin skin, easy bruising, striae/stretch marks (increase fat, lose protein)
proximal myopathy - weakness of large muscles
mental changes - depression as steroids affect CNS
hypertension
fat redistribution (centripetal obesity - lemon on sticks)
inter-scapular fat/buffalo pad
hirsutism/acne - zona reticularis secretes more testosterone
immunosuppression (TB reactivation)

Question 16

What is Cushing’s Syndrome?

Answer 16

excess cortisol
also excess of any other glucocorticoid
- take steroids by mouth
- pituitary adenoma producing too much ACTH (Cushing’s Disease)
- Ectopic ACTH (lung cancer cells can produce ACTH)
- adrenal adenoma/carcinoma

Question 17

What is the difference between Cushing’s syndrome and disease?

Answer 17

syndrome = collection of symptoms with any cause
disease = cause is PITUITARY ADENOMA

Question 18

What are the side effects of steroids similar to ?

Answer 18

Cushing’s syndrome

hypertension, diabetes, osteoporosis, reactivation of infection, easy bruising, poor wound healing, thin skin

Question 19

What is Conn’s syndrome?

Answer 19

aldosterone producing adenoma
tumour of zona glomerulosa 
- retain Na and lose K
- hypertension
- oedema 
- low blood K

Question 20

What is made by the zona reticularis?

Answer 20

testosterone

Question 21

How is progesterone formed from cholesterol?

Answer 21

cholesterol side chain cleaved
form pregnenolone
this is oxidised to give progesterone

Question 22

What is the cause of bitemporal hemianopia?

Answer 22

optic nerve chiasm compression (where information decussates across the optic nerve)
confirms pituitary tumour >10mm (macroadenoma)
middle and outer areas of retina not working

Question 23

How to ensure no child whilst breastfeeding?

Answer 23

very high prolactin

inhibits FSH/LH

Question 24

How to treat pituitary tumour?

Answer 24

if acromegaly/cushings operate
if prolactinoma do not operate
- use dopamine agonist to cause tumour to shrink
- cabergolin/bromcriptine
- may become resistant