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Phase 2 (again) > Adrenal disorders > Flashcards

Adrenal disorders Flashcards

1
Q

Features of Cushing’s syndrome (4)

A
  1. Excess cortisol
  2. Loss of hypothalamic pituitary axis feedback
  3. Loss of circadian rhythm
  4. Most commonly caused by steroids or ACTH
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2
Q

Define Cushing’s disease

A

Cushing’s syndrome specifically caused by pituitary adenoma. Bilateral adrenal hyperplasia.
30-50y

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3
Q

Define Cushing’s syndrome

A

Abnormalities caused by excess circulating glucocorticoids (from any cause)

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4
Q

Causes of Cushing’s syndrome (6)

A
  1. Cushing’s disease
  2. Ectopic ACTH production - small cell lung cancer, carcinoid tumours
  3. Ectopic CRF production - some thyroid medullary and prostate cancers
  4. Iatrogenic
  5. Adrenal adenoma/cancer
  6. Adrenal nodular hyperplasia
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5
Q

Symptoms of ectopic ACTH production (4)

A
  1. Hyperpigmentation (increased ACTH)
  2. Hypokalaemia metabolic alkalosis
  3. Hyperglycaemia
  4. Weight loss
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6
Q

Pathology of Cushing’s syndrome (3)

A
  1. Excess ACTH -> excess cortisol production
  2. Pathology in adrenals -> zona reticularis stimulated to produce more cortisol
  3. Synthetic glucocorticoids
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7
Q

Symptoms of Cushing’s syndrome: CUSHING

A 
Cataracts
Ulcers
Striae - purple stripes on abdomen
Hypertension and hyperglycaemia
Increased risk of infection
Necrosis
Glucosuria
(also amenorrhea - absence of period)
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8
Q

Signs of Cushing’s disease (7)

A
  1. Truncal/central obesity
  2. Moon face
  3. Buffalo hump - fatty lump on upper back
  4. Acne
  5. Hirsutism - male hair pattern in females
  6. Thin skin/bruising
  7. Osteoporosis
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9
Q

Investigations of Cushing’s syndrome (5)

A
  1. Random cortisol test - if high proceed to next
  2. Overnight dexamethasone suppression test
  3. Check 24h urinary free cortisol measurement - if normal Cushing’s unlikely
  4. CT/MRI
  5. Plasma ACTH
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10
Q

Differential diagnosis of Cushing’s syndrome

A

Pseudo-cushing’s - caused by excess alcohol consumption and resolves after 1-3wks abstinence

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11
Q

Treatment of Cushing’s syndrome (5)

A
  1. Iatrogenic - stop drugs
  2. Cushing’s disease - transphenoidal removal of pituitary adenoma
  3. Adrenal adenoma - adrenalectomy
  4. Adrenal carcinoma - adrenalectomy, RT, adrenolytic drugs
  5. Ectopic ACTH - surgery to remove tumour
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12
Q

Define acromegaly

A

Excessive production of growth hormone in adults after epiphyseal fusion

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13
Q

Causes of acromegaly (2)

A
  1. Benign GH-producing pituitary adenoma - develops over years
  2. Ectopic GH-producing hormone from carcinoid tumour
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14
Q

RF acromegaly

A

Associated with multiple endocrine neoplasia - MEN-1

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15
Q

Pathology of acromegaly

A

Increased GH production -> increased IGF-1 -> stimulates skeletal and soft tissue growth - giant like appearance.
Local tumour expansion in pituitary gland will apply pressure to surrounding structures causing headaches and vision field loss

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16
Q

Symptoms of acromegaly (6)

A
  1. Acroparaesthesia
  2. Arthralgia
  3. Amenorrhoea/oligomenorrhoea
  4. Sweating
  5. Decreased libido/impotence
  6. Galactorrhoea
17
Q

Signs of acromegaly (10)

A
  1. Acral enlargement - hands, feet, jaw
  2. Big tongue and widely spaced teeth
  3. Prominent supraorbital ridge
  4. Puffy eyelids, lips, skin
  5. Darkening skin
  6. Obstructive sleep apnoea
  7. Thick skin
  8. Deep voice
  9. HTN
  10. HF
18
Q

Investigations for acromegaly (6)

A
  1. Oral glucose tolerance test - usually glucose will reduce GH in blood
  2. Serum IGF-1 levels - raised
  3. Pituitary fossa MRI
  4. Visual field tests
  5. ECG and echocardiogram
  6. Serum prolactin - can be raised from adenoma
19
Q

Treatment of acromegaly

A
  1. First line - transphenoidal surgical resection of pituitary adenoma
  2. Second line - somatostatin analogues (suppress GH secretion), dopamine agonist, GH antagonist, external radiotherapy
20
Q

Define Conn’s syndrome

A

Hyperaldosteronism due to primary aldosterone producing adenoma

21
Q

RF Conn’s

A

HTN

22
Q

Pathology of Conn’s

A
  • Excess production of aldosterone independent of the RAAS system
  • Increased K+ loss, Na+ and water retention -> BP increase
  • Decreased renin release
  • Hypokalaemia
23
Q

Symptoms of Conn’s

A 
1. Usually asymptomatic 
Hypokalaemia symptoms:
2. Constipation
3. Muscle weakness and cramps
4. Polyuria and polydipsia
5. Paraesthesia
6. Sweating attacks - unusual
24
Q

Signs of Conn’s

A
  1. HTN as result of increased blood vol

2. Cardiac arrhythmias - especially in patients with cardiac disease

25
Q

Differential diagnosis of Conn’s

A

Secondary hyperaldosteronism - excess renin

Causes: renal artery stenosis, accelerated HTN, diuretics, hepatic failure, congestive heart failure

26
Q

Investigations for Conn’s

A
  1. U&Es - decreased renin, increased aldosterone
  2. ECG - U waves, flat T waves, Long PR, Long QT, ST depression
  3. Adrenal CT/MRI
27
Q

Treatment for Conn’s

A
  1. Laparoscopic adrenalectomy

2. Spironolactone - K+ sparing diuretic - aldosterone antagonist

Phase 2 (again) (24 decks)

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