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Endocrinology > Adrenal Disorders > Flashcards

Adrenal Disorders Flashcards

1
Q

What is Cushings?

A

Hypercortisolism

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2
Q

What is Conn’s?

A

Hyperaldosteronism

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3
Q

What is Addison’s?

A

Hypoadrenalism

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4
Q

What happens in Conn’s?

A

Excessive aldosterone causes Na retention, increased plasma and ECF volume, hypokalaemia and HTN
All supresses Renin
Alkalosis

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5
Q

What causes Conn’s?

A 
Adrenal adenoma (70%)
Bilateral adrenal hyperplasia
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6
Q

What causes secondary hyperaldosteronism?

A

Renal artery stenosis/obstruction
Heart Failure
Causes high renin which stimulates aldosterone production

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7
Q

What are symptoms and signs of Excessive aldosterone?

A

HTN- LVH/MI renal failure
Hypernatraemia signs
Hypokalaemia- DI, thirst, polyuria, polydipsia, neuromuscular weakness, tetany and paraesthesia

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8
Q

How do you investigate Hyperaldosteronism?

A

Exclude other causes of hypokalaemia (diuretics/laxatives)
Measure aldosterone:renin ratio
Imaging

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9
Q

What is the mechanism of Cushings?

A

Chronic excessive cortisol and loss of circadian rhythms

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10
Q

Who gets cushings?

A

Male

Prepubescent

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11
Q

What is the difference between Cushings disease and syndrome?

A

Syndrome- Adrenal adenoma/ steroids/ paraneoplastic- 30%

Disease- Pituitary tumour (ACTH dependent)- 70%

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12
Q

What are clinical features of cushings?

A 
HTn
Central obesity
Hirsutism
DM
Osteoporosis
Straie
Red Moon face
Bufalo hump
Depression and psychosis
Impotence
Hypokalaemia
Acne
Recurrent achilles tendonitis
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13
Q

How is Cushing investigated?

A

Repeated tests and clinical judgement needed
DEXAMETHASONE supression test- then measure ACTH and cortisol in the morning to see if morning spike reduced. First low dose then high
If pit cause= ACTH low, cort low
If adrenal cause+ ACTH low cort high

24 hour free cortisol (>2 measurements) and measure ACTH

Imaging

Refer to endocrinology

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14
Q

When do you get high cortisol physiologically?

A 
Pregnancy
Depression
Morbid obesity
DM
Alcohol dependence
Stress
Malnutrition
Chronic excercise
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15
Q

How is Cushings managed?

A

Surgery/radio

Cabergoline to act on pit or Ketoconadazole or mifepristone to act on adrenals

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16
Q

What is the mechanism in Addisons?

A

Adrenal insufficiency means reduced aldosterone and cortisol

17
Q

What causes primary adrenal insufficiency?

A

Addisons- autoimmune destruction of cortex
TB
Lymphoma

18
Q

How is primary adrenal insufficiency diagnosed?

A

9am cortisol low
Increased ACTH
Low Aldosterone
Syntrophin test

19
Q

What causes secondary adrenal insufficiency?

A

Steroid excess supresses adrenal axis
Pituitary tumours
Head trauma

20
Q

What is most common cause of adrenal insufficiency

A

CAH

21
Q

What are symptoms of adrenal insufficiency>

A 
Anorexia
Weakness and fatigue
Weight loss
Hyperpigmented palms (lean and tanned)
Nausa and pain
Hypotension
Salt cravings
Loss of libido
Tachycardia
Postural dizziness
Tearful
22
Q

What are biochemical signs of adrenal insufficiency?

A 
Hyponatramia
Hypoglycaemia
Hypercal
Hyperkal
Anaemia
Eosinophilia
Lymphocytosis
Increased liver transaminases
High TSH
23
Q

What is management of adrenal insufficiecy?

A

Daily Hydrocortisone
Daily Fludrocortisone
Double doses when sick

24
Q

What is the syacthen test?

A

syACTHen test- given synthetic ACTH and cortisol measured baseline, 30 and 60 mins after and cortisol response measured

25
Q

What happens in an acute addisonian crisis?

A

Imbalance caused by vomit/diarrhoea, infection, surgery, MI, hypoglycaemia meaning acute lack of steroids

26
Q

How does an addisonian crisi present/

A 
Nausea
Abdo pain
Muscle cramps
Confusion
Hypotension
Hyponat
HyperK
27
Q

How is an addisonian crisis managed?

A

IV HYDROCORTISONE bolus then infusion
Fluid resus
Correct glucose and monitor UandE

28
Q

What is a phaemochromocytoma?

A

Adrenaline producing tumour of chromaffin cells in adrenals

29
Q

How is adrenaline produced in phaeochromocytoma?

A

in bursts

30
Q

WHat is phaeochromocytoma associated with?

A

Multiple Neuroendocrine Neopolasia (MEN 2)

Neurofibromatosis

31
Q

What are clinical features of phaeochromocytoma?

A 
HTN
Palpitations
Pallor
Anxiety
Tremor
Sweating
Weakness
Fatigue
Weight loss
Hyperglycaemia
32
Q

How is phaeochromocytoma investigated?

A

24 hour urine catecholamine collection and plasma metanephrine
CT/MRI

33
Q

How is phaeochromocytoma managed?

A

BP control- alpha blocker (PHENOXYBENZAMINE) or CCBs then BBs once established on alpha blockers
Adrenalectomy with alpha blocker to prevent hypertensive crisis in theathre

34
Q

What does Aldosterone do?

A

Causes increased sodium and water retention increasing BP

35
Q

What does ADH do?

A

Increases absorbtion of sodium and water in the collecting ducts through the AQP-2 channels and therefore concentrating the urine

Endocrinology (9 decks)

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