Adrenal disorders Flashcards
How may adrenal hormone deficiency present?
Cortisol, mineralocorticoid (aldosterone) and androgen
Cortisol = weakness, tiredness, weight loss, hypoglycaemia Mineralocorticoid = dizziness, low Na and high K Androgen = low libido and loss of body hair in women
How may adrenal hormone excess present?
Cortisol, mineralocorticoid (aldosterone) and androgen
Cortisol = weight gain and cushingoid features Mineralocorticoid = high BP and low K Androgen = increased male characteristics in women
How may excess ACTH present?
Skin pigmentation (melanocyte stimulation) -Seen in Addison's and ACTH-driven cushings
How may an adrenal medulla disease present?
Excessive catecholamine secretion (e.g. adrenaline)
- Sweating
- Anxiety
- Palpitations
- High or low BP
- Collapse
- Sudden death
What would the results be for a biochemical assessment for adrenal cortex hormone deficiency?
Low Na and high K (aldosterone effects)
What would the results be for a biochemical assessment for adrenal cortex hormone excess?
- High BP
- Low K
- High midnight cortisol
What biochemical assessments are used for diseases of the adrenal medulla?
- 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
What are some radiological assessments to consider for an adrenal disease?
- CT scan
- MRI scan
- PET scan
What are the three types of adrenal insufficiency?
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
What are the signs of Addison’s disease?
- Weakness
- Fatigue
- Anorexia
- Dizziness
- Weight loss
- Nausea
- Abdominal pain
- Pigmentation
What are the symptoms of Addison’s disease?
- Underweight
- General malaise
- Vitiligo
- Postural hypotension
- Pigmentation
What are the potential causes of Addison’s disease?
- Auto-immune
- Infection e.g. TB, fungal, AIDS
- Infiltration
- Malignancy
- Genetic
- Vascular
- Latrogenic
How is Addison’s disease treated?
- Lifelong replacement = glucocorticoid (hydrocortisone, prednisolone), mineralocorticoid (fludrocortisone)
- Education to prevent crisis = emergency injection, double dose glucocorticoid at times of illness
What is Cushing’s syndrome?
Chronic excessive exposure to cortisol
What is the difference between Cushing’s syndrome and Cushing’s disease?
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
What are the potential causes of Cushing’s syndrome? (3)
1) Pituitary tumour
2) Adrenal tumour
3) Ectopic ACTH releasing tumour
How may an adrenal tumour present?
ACTH suppression (from negative feedback)
- Hirsutism
- Acne
- Greasy skin
- Androgenic
- Alopecia
- Deep voice
- Clitomegaly
What is the treatment for an adrenal tumour?
Adrenalectomy
-Can be laparoscopic (key hole surgery), need open surgery for bigger tumours
What is primary hyperaldosteronism?
Excess production of aldosterone from adrenal gland (defect in the adrenal gland)
What is Conn’s syndrome?
Aldosterone-secreting adrenal adenoma
What is a warning signs for a primary hyperaldosteronism?
- Hypertension
- Hypokalaemia
- High aldosterone
- Suppressed renin
What is congenital adrenal hyperplasia?
An autosomal recessive condition that leads to a blockage in adrenal cortex pathway of hormone synthesis (most commonly 21-hydroxylase)
What are the complications of congenital adrenal hyperplasia?
Adrenal crisis and ambiguous genitalia
How may congenital adrenal hyperplasia present?
- Hypotension
- Hyponatraemia
- Hypoglycaemia
- Hyperkalaemia
What is the treatment for congenital adrenal hyperplasia?
- Corrective surgery
- Treat adrenal crisis
- Determine the sex of the baby
- Long term glucocorticoids and mineralocorticoids
What is Phaeochromocytoma?
A tumour of the adrenal medulla
What is Paraganglioma?
An extra-adrenal tumour (chromaffin)
How is adrenal medulla disease (tumour) managed?
1) a-blockade
2) b-blockade
3) surgical excision
