Adrenal disorders Flashcards
the medulla of the adrenal gland is
primitive nerve tissue
the cortex of the adrenal gland is
endocrine tissue (deep you o the sweeter its gets
Zona glomerulosa
Salt and water- mineralocorticoids
Zona fasciculata
Sugar -glucocorticoids
Zona reticularis
Sex- androgen
Disorders of the adrenal cortex
Adrenal insufficiency’s
Cushing’s
Hyperaldosteronism
Congenital adrenal hyperplasia (CAH)
Disorders of the adrenal medulla
Pheochromocytoma (dusty coloured cell of a tumour)
Paraganglioma (pheochromocytoma outside the adrenal gland)
Presentation of adrenal medulla disease (noradrenaline/ adrenaline)
- Excessive catecholamine secretion
- Acute episodes
- Sweating
- Palpitations
- High or low BP
- Collapse
- SUDDEN DEATH
Biochemical assessment of adrenal medulla
- 24h urine catecholamines
- Adrenaline
- NA
- Dopamine
- 3-methoxy-tyramine
-
Usually measure breakdown products of catecholamines- Metanephrines24 h urine metanephrines
- Metadrenaline
- Normetadrenaline
-
Plasma metanephrines (more sensitive than 24h urine)
- Avoid certain foods: coffee, coke, bananas, chocolate, vanilla
Clinical presentation of adrenal cortex disease: Cortisol (lack of glucocorticoid) deficiency
weakness, tiredness, weight loss, hypoglycaemia
*Cortisol does the opposite to insulin*
Clinical presentation of adrenal cortex disease: Mineralocorticoid (aldosterone) deficiency
– dizziness, hypotension, low Na, high K
Clinical presentation of adrenal cortex disease: Androgen deficiency– e.g. Addisons
- In women- low libido and loss of body hair in women
- Testosterone only produced in adrenal gland in women
- In men- no symptoms because produced in testosterone
Clinical presentation of adrenal cortex disease: Cortisol excess
- Weight gain and cushingoid features (cushing’s syndrome)
- Diabetes
- Bone weakness
Clinical presentation of adrenal cortex disease: Mineralocorticoid excess (aldosterone)-
high BP and low K
Clinical presentation of adrenal cortex disease: androgen excess
increased male characteristics in women
ACTH excess from pituitary
- Skin pigmentation due to melanocyte stimulation
- Pigmentation seen in Addisons and ACTH- driven cushings
Biochemical assessment of adrenal cortex: Suspected adrenal hormone deficiency
- Electrolytes- low Na, high K in aldosterone deficiency
- 0900 basal cortisol- low when it should be high
- Stimulation test- inject synthetic ACTH (synacthen)
- ACTH stimulates cortisol
Biochemical assessment of adrenal cortex :Suspected adrenal hormones excess
- Electrolyte- high BP, low K
- Midnight cortisol- high, should be low
- 24h urine cortisol- high
- Suppression test- failure to suppress
- Androgens and derivatives – high
Radiological assessment of adrenal disease
CT scan
Radiological assessment of adrenal disease
MRI scan
Radiological assessment of adrenal disease
functional imaging - MIBG scan
Radiological assessment of adrenal disease
functioning imaging - PET scan
adrenal cortex disorders are related to which hormones
aldosterone, cortisol and androgens
Hperaldosteronisms
A condition in which there is excessive production of aldosterone.
Primary hyperaldosteronism:
excess aldosterone production due to a defect in the adrenal cortex. Commonoest form of endocrine hypertension.
- Bilateral idiopathic adrenal hyperplasia
- Or Aldosterone-secreting adenoma (Conns syndrome)
diagnosis of primary hyperaldosteornism
- Hypertension and hyperkalaemia
- Elevated aldosterone independent of RAAS (suppressed renin)
- Scan- shows adrenal adenoma or bilateral hyperplasia
Secondary hyperaldosteronism:
- excess aldosterone production due to overactivity of the RAAS
- Renin- producing tumour or renal artery stenosis
signs and symptoms of hyperaldosteronism
- High blood pressure
- Left ventricular hypertrophy
- Stroke
- Hypernatremia
- Hypokalaemia
treatment of hyperalsteronism
- Dependent on cause
- Surgical treatment for aldosterone-secreting adenomas or
- Spironolactone (a mineralocorticoid receptor agonists) can be used for other causes
what is a disorder cause dby excessive exposure to cortisol
cushing’s syndrome
causes of cushing’s syndrome can be
exogenous or endogenous
exogenous causes of cushing’s syndrome
main cause is being prescribed glucocorticoids
endogenous causes of main cause cushing’s syndrome
- Cushing’s disease: benign pituitary adenoma that secretes ACTH
- Adrenal cushing’s: Adrenal tumour secreting glucocorticoids
- Non- pituitary-adrenal tumours producing ACTH and/ or CRH (e.g. small cell lung cancer- very rare)
Signs and symptoms of Cushing’s syndrome
- Moon shaped face
- Buffalo hump
- Abdominal obesity
- Striae
- Acute weight gain
- Hyperglycaemia – increased gluconeogenesis
- Hypertension- mineralocorticoid effects of excess cortisol