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MEH > Adrenal Disordes > Flashcards

Adrenal Disordes Flashcards

1
Q

What are the symptoms of adrenal hormone deficiency

A

Cortisol - weakness, tiredness, weight loss, hypoglycaemia
Mineralocorticoid - dissiness, low Na, high K
Androgen - low libido and loss of body hair in women

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2
Q

What are the symptoms of adrenal hormone excess

A

Cortisol - weight gain and cushings I’d fetures
Mineralocorticoid- high be and low k
Androgen - increased male characteristics in woman

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3
Q

What is seen in acth excess from pituitary

A

• Skin pigmentation pigmentation seen in Addison’s and ACTH driven cushings melanocyte stimulation

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4
Q

What is the presentation of adrenal medulla disease

A
  • Acute episodes
  • Sweating
  • Anxiety
  • Palpitations
  • High or low BP
  • Collapse

Sudden death

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5
Q

What tests should be performed for suspected adrenal hormone deficiency

A

Electrolytes - low Na, High K in aldosterone def
9:00 basal cortisol - it should be high here
Stimulation test - inject synthetic acth (synacthen)

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6
Q

What tests should be reformedd for suspected adrenal hormone excess

A
  • Electrolytes - high BP, low K
  • Midnight cortisol - high -when it should be low
  • 24h urine cortisol - high
  • Suppression test - failure to suppress
  • Androgens and derivatives - high
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7
Q

Describe the biochemical assessment of the adrenal medulla

A

24h urine catecholamines adrenaline, noradrenaline, dopamine, 3-Methoxy-Tyramine

24h urine metanephrines metabolites of adrenaline and noradrenaline metadrenaline, normetadrenaline

plasma metanephrines more sensitive than 24h urine

avoid certain foods before collection coffee, coke, bananas, chocolate, vanilla

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8
Q

What results from adrenal insufficiency

A 
Primary adrenal failure
destruction of adrenal cortex Addison’s
ACTH deficiency from hypopituitarism
Secondary adrenal failure Steroid-induced hypoadrenalism
ACTH suppression
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9
Q

What are the symptoms of Addison’s disease

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

Signs
• Underweight • Signs of weight loss • General malaise • Other auto-immune disease • Vitiligo • Thyroid
• Postural hypotension • Pigmentation

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10
Q

What are the causes of primary adrenal failure

A 
Auto-immune isolated or polyglandular 
Infection TB, fungal, AIDS 
Infiltration amyloid, haemochromatosis 
Malignancy lung, breast, kidney 
Genetic CAH, adreno-leukodystrophy 
Vascular haemorrhage or infarction 
Iatrogenic adrenalectomy, drugs
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11
Q

What ae teh clinical features and treatment of adrenal crisis

A
  • Collapse • Hypotension • Dehydration • Pigmentation • Coma
  • Rapid rehydration with fluids • Intravenous hydrocortisone • Correction of hypoglycaemia • Search for precipitating cause
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12
Q

What is the maintenance treatment of assistants disease?

A

Lifelong replacement glucocorticoid - hydrocortisone, prednisolone what is the maintenance treatment of Addison’s disease?mineralocorticoid - fludrocortisone
Education to prevent crises double dose glucocorticoid at times of illness emergency HC injection if vomiting steroid card and bracelet

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13
Q

What is acth deficiency?

A

ACTH deficiency
Occurs in any cause of hypopituitarism
Similar symptoms to primary adrenal failure
No pigmentation as ACTH not raised
No hyperkalaemia as no mineralocorticoid deficiency Hyponatraemia due to effect of cortisol on free water excretion

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14
Q

What is steroid induced hypoadrenalism

A

Steroid-induced hypoadrenalism
ACTH suppressed with long-term steroids
Abrupt withdrawal can cause hypo-adrenal crisis
Important to consider in any unwell patient on steroids

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15
Q

What are the symptoms of Cushing’s syndrome

A
  • Round pink face with round abdomen
  • Skinny and weak arms and legs
  • Thin skin and easy bruising
  • Red stretch marks (‘striae’) on abdomen
  • High blood pressure and diabetes
  • Osteoporosis (thin bones)
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16
Q

What are the causes of Cushing’s syndrome

A

Pituitary tumour
Adrenal tumour
Ectopic ACTH

17
Q

Describe the presentation of adrenal Cushing’s syndrome

A

ACTH is suppressed ‘ACTH-independent’ cushing’s unlike pituitary and ectopic ACTH ‘ACTH-dependent’

androgenic symptoms may be present hirsutism, acne, greasy skin
virilising features in large tumours androgenic alopecia, deep voice, clitoromegaly

18
Q

What is primary hyperaldosteronism

A

excess production of aldosterone from adrenal gland aldosterone-secreting adrenal adenoma - Conn’s syndrome
bilateral adrenal hyperplasia - no discrete adenoma

19
Q

What is primary hyperaldosteroism

A

Commonest form of endocrine hypertension Hypertension at young age or refractory to treatment
Combination of hypertension and hypokalaemia (low potassium)
Elevated aldosterone independent of renin-angiotensin system

20
Q

Deserves ethe diagnosis of primary hyperaldosteronism

A

clinical suspicion – hypertension and hypokalaemia confirmation of high aldosterone and suppressed renin scan shows adrenal adenoma or bilateral hyperplasia
if lesion too small may need sampling or functional scan
Conn’s adenoma amenable to surgery bilateral hyperplasia treated with aldosterone antagonists spironolactone / eplerinone

21
Q

What is CAH?

A

Congenital Adrenal Hyperplasia (CAH)
Rare but important inherited disorder
Autosomal recessive
Adrenal crisis and ambiguous genitalia
Caused by a block in adrenal cortex pathway
Presentation depends on enzyme defect
Lack of enzyme leads to: Low cortisol and aldosterone High male hormone (androgens)

22
Q

Describe the presentation and treatment of CAH

A

Presentation
Hypotension Hyponatraemia Hyperkalaemia Hypoglycaemia Virilisation

Treatment 
Treat adrenal crisis 
Determine sex of baby 
Long term GC and MC 
Corrective surgery
23
Q

What are phaeochromocytoma and paraganglioma

A 
Phaeochromocytoma
Tumour of adrenal medulla
Paraganglioma
Extra-adrenal tumour
chromaffin tissue origin
90% from adrenal medulla
10% extra-adrenal origin
Genetic inheritance common
More likely if:
• Extra-adrenal
• Malignant
• Bilateral
24
Q

What are the symptoms of phaeochromocytoma and paraganglioma

A 
Symptoms
• Acute episodes
• Sweating
• Panic attacks
• Palpitations
• High or low BP
• Collapse
Acute Crisis 
• Hypertensive crisis 
• Encephalopathy 
• Hyperglycaemia 
• Cardiac arrhythmias 
• Sudden Death
25
Q

What are investigations for phaeochromocytoma and paraganglioma

A

Investigations
24h urine metanephrines
2-3 x collections needed
Plasma metanephrines

Neuro-endocrine marker Chromogranin A

26
Q

Describe the management of phaeochromocytoma and paraganglioma

A

Management α-blockade β-blockade surgical excision
Important to α-block before β-blockade Unopposed α-stimulation can cause a hypertensive crisis
phenoxybenzamine bisoprolol
Peri-operative management Specialist anaesthetic team Risk of crisis during operation Maximal vasodilation and filling with IV fluid

27
Q

What are the familial causes of phaeochromocytoma and paraganglioma

A

Familial causes

Multiple Endocrine Neoplasia type 2
Von Hippel-Lindau
Neurofibromatosis type 1
Succinate dehydrogenase subunit B and D
MEN-2- medullary thyroid cancer, hyperparathyroidism
VHL - renal cancer, cerebellar hamangioblastoma, angiomas
NF1 - café au-lait patches, neurofibromas
SDHB/Dphaeos, paragangliomas in neck, thorax, abdomen

MEH (21 decks)

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