Adrenal Disorders

Question 1

What are the signs of cortisol deficiency?

Answer 1

Weakness
Tiredness
Weight loss
Hypoglycaemia

Question 2

What are the signs of mineralocorticoid deficiency?

Answer 2

Dizziness
Low sodium
High potassium

Question 3

What are the signs of androgen deficiency?

Answer 3

Low libido

Loss of body hair in women

Question 4

What are the signs of cortisol excess?

Answer 4

Weight gain

Cushingoid features

Question 5

What are the signs of mineralocorticoid excess?

Answer 5

High BP

Low sodium

Question 6

What are the signs of androgen excess?

Answer 6

Increased male characteristics in women

Question 7

Presentation of excessive catecholamine secretion

Answer 7

Acute episodes

Sweating 
Anxiety
Palpitations 
High/low BP
Collapse

Question 8

What is primary adrenal failure?

Answer 8

Destruction of adrenal cortex

Addison’s

Question 9

What is secondary adrenal failure?

Answer 9

ACTH deficiency from hypopituitarism

Question 10

What is steroid-induced hypoadrenalism?

Answer 10

ACTH suppression

Question 11

What are symptoms of Addison’s disease?

Answer 11

Fatigue 
Weakness
Weight losss
Nausea
Abdominal pain 
Pigmentation

Question 12

What are causes of primary adrenal failure?

Answer 12

Autoimmune

Infection

• TB
• fungal
• AIDS

Infiltration

• amyloid
• haemochromatosis

Malignancy

Question 13

What are the clinical features of an adrenal crisis?

Answer 13

Collapse
Hypotension
Dehydration
Pigmentation

Question 14

What do the blood tests show in an adrenal crisis?

Answer 14

Hyponatraemia
Hyperkalaemia

High urea
High creatinine

Low cortisol

Question 15

What is the treatment for an adrenal crisis?

Answer 15

IV Hydrocortison
IV fluids - rapid
Correction for hypoglycaemia

Search for cause

Question 16

Maintenance treatment for Addison’s disease

Answer 16

Glucocorticoid

• hydrocortisone
• prednisolone

Mineralocorticoid
- fludrocortisone

Education

• double dose during illness
• steroid card

Question 17

What is Cushing’s syndrome?

Answer 17

Glucocorticoid excess

Question 18

Signs of Cushing’s

Answer 18

Round pink face
Skinny/weak arms 
Thin skin 
Purple abdomen striae
High BP
Osteoporosis

Question 19

Causes of Cushing’s

Answer 19

Pituitary tumour
Adrenal tumour
Ectopic ACTH

Question 20

What is adrenal Cushing’s syndrome?

Answer 20

Adrenal tumour secreting glucocorticoids

Question 21

How does adrenal Cushing’s syndrome present?

Answer 21

ACTH supressed

Adrogenic symptoms

• hirsutism
• acne
• greasy skin

Question 22

Treatment for adrenal Cushing’s syndrome

Answer 22

Adrenalectomy

Question 23

What is primary hyperaldosteronism ?

Answer 23

Excess production of aldosterone from adrenal gland

Question 24

What can cause primary hyperaldosteronism?

Answer 24

Conn’s syndrome
Aldosterone secreting adrenal adenoma
Bilateral adrenal hyperplasia

Question 25

What are the signs of primary hyperaldosteronism?

Answer 25

Hypertension
Hypokalaemia
Elevated aldosterone
Suppressed renin

Question 26

What is CAH?

Answer 26

Congenital adrenal hyperplasia

• autosomal recessive
• adrenal crisis + ambiguous genitalia

Question 27

How does CAH present?

Answer 27

Hypotension 
Hyponatramia 
Ambiguous genitalia 
Hyperkalaemia 
Hypoglycaemia

Question 28

How do you treat CAH?

Answer 28

Treat adrenal crisis
Determine sex of baby
Long term glucocorticoids + mineralocorticoids

Question 29

What is a phaechromocytoma?

Answer 29

Tumour of adrenal cortex

Question 30

What is a paraganglioma?

Answer 30

Extra-adrenal tumour

Question 31

What are the symptoms of phaechromocytoma?

Answer 31

Acute episodes

Sweating
Panic attacks
Palpitation

Question 32

How do you manage phaechromocytoma?

Answer 32

alpha blockade - phenoxybenazmine
beta blockade - bisoprolol

alpha block first

Surgical excision