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METABOLISM, ENDOCRINOLOGY AND HAEMATOLOGY > Adrenal disorders > Flashcards

Adrenal disorders Flashcards

1
Q

How may adrenal hormone deficiency present?

Cortisol, mineralocorticoid (aldosterone) and androgen

A 
Cortisol = weakness, tiredness, weight loss, hypoglycaemia
Mineralocorticoid = dizziness, low Na and high K
Androgen = low libido and loss of body hair in women
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2
Q

How may adrenal hormone excess present?

Cortisol, mineralocorticoid (aldosterone) and androgen

A 
Cortisol = weight gain and cushingoid features
Mineralocorticoid = high BP and low K
Androgen = increased male characteristics in women
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3
Q

How may excess ACTH present?

A 
Skin pigmentation (melanocyte stimulation)
-Seen in Addison's and ACTH-driven cushings
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4
Q

How may an adrenal medulla disease present?

A

Excessive catecholamine secretion (e.g. adrenaline)

  • Sweating
  • Anxiety
  • Palpitations
  • High or low BP
  • Collapse
  • Sudden death
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5
Q

What would the results be for a biochemical assessment for adrenal cortex hormone deficiency?

A

Low Na and high K (aldosterone effects)

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6
Q

What would the results be for a biochemical assessment for adrenal cortex hormone excess?

A
  • High BP
  • Low K
  • High midnight cortisol
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7
Q

What biochemical assessments are used for diseases of the adrenal medulla?

A
  • 24h urine catecholamines (dopamine, adrenaline, nor-adrenaline)
  • 24h urine metanephrines (metabolites of adrenaline)
  • Plasma metanephrines (more sensitive)

Must avoid certain foods before collection e.g. coffee, coke, bananas

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8
Q

What are some radiological assessments to consider for an adrenal disease?

A
  • CT scan
  • MRI scan
  • PET scan
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9
Q

What are the three types of adrenal insufficiency?

A

1) Primary adrenal failure = destruction of adrenal cortex (Addison’s disease)
2) Secondary adrenal failure = ACTH deficiency from hypopituitarism
3) Steroid induced hypoadrenalism = ACTH supression

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10
Q

What are the signs of Addison’s disease?

A
  • Weakness
  • Fatigue
  • Anorexia
  • Dizziness
  • Weight loss
  • Nausea
  • Abdominal pain
  • Pigmentation
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11
Q

What are the symptoms of Addison’s disease?

A
  • Underweight
  • General malaise
  • Vitiligo
  • Postural hypotension
  • Pigmentation
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12
Q

What are the potential causes of Addison’s disease?

A
  • Auto-immune
  • Infection e.g. TB, fungal, AIDS
  • Infiltration
  • Malignancy
  • Genetic
  • Vascular
  • Latrogenic
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13
Q

How is Addison’s disease treated?

A
  • Lifelong replacement = glucocorticoid (hydrocortisone, prednisolone), mineralocorticoid (fludrocortisone)
  • Education to prevent crisis = emergency injection, double dose glucocorticoid at times of illness
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14
Q

What is Cushing’s syndrome?

A

Chronic excessive exposure to cortisol

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15
Q

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

A

Cushing’s syndrome is the broad term for the condition of excessive cortisol exposure whilst Cushing’s disease is specifically from an ACTH releasing pituitary adenoma

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16
Q

What are the potential causes of Cushing’s syndrome? (3)

A

1) Pituitary tumour
2) Adrenal tumour
3) Ectopic ACTH releasing tumour

17
Q

How may an adrenal tumour present?

A

ACTH suppression (from negative feedback)

  • Hirsutism
  • Acne
  • Greasy skin
  • Androgenic
  • Alopecia
  • Deep voice
  • Clitomegaly
18
Q

What is the treatment for an adrenal tumour?

A

Adrenalectomy

-Can be laparoscopic (key hole surgery), need open surgery for bigger tumours

19
Q

What is primary hyperaldosteronism?

A

Excess production of aldosterone from adrenal gland (defect in the adrenal gland)

20
Q

What is Conn’s syndrome?

A

Aldosterone-secreting adrenal adenoma

21
Q

What is a warning signs for a primary hyperaldosteronism?

A
  • Hypertension
  • Hypokalaemia
  • High aldosterone
  • Suppressed renin
22
Q

What is congenital adrenal hyperplasia?

A

An autosomal recessive condition that leads to a blockage in adrenal cortex pathway of hormone synthesis (most commonly 21-hydroxylase)

23
Q

What are the complications of congenital adrenal hyperplasia?

A

Adrenal crisis and ambiguous genitalia

24
Q

How may congenital adrenal hyperplasia present?

A
  • Hypotension
  • Hyponatraemia
  • Hypoglycaemia
  • Hyperkalaemia
25
Q

What is the treatment for congenital adrenal hyperplasia?

A
  • Corrective surgery
  • Treat adrenal crisis
  • Determine the sex of the baby
  • Long term glucocorticoids and mineralocorticoids
26
Q

What is Phaeochromocytoma?

A

A tumour of the adrenal medulla

27
Q

What is Paraganglioma?

A

An extra-adrenal tumour (chromaffin)

28
Q

How is adrenal medulla disease (tumour) managed?

A

1) a-blockade
2) b-blockade
3) surgical excision

METABOLISM, ENDOCRINOLOGY AND HAEMATOLOGY (19 decks)

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