Adrenal Gland

Question 1

Before measuring aldosterone/plasma renin activity ratio. Which drug should be stopped?

Answer 1

Beta-blockers & spironolactone

B-blockers causes ⬆️ of the renin concentration

( While ACE inhibitors actually improves test sensitivity )

Question 2

What’s the diagnostic test for Acromegaly?

Answer 2

Oral glucose tolerance test ( failure of GH Suppression during an OGTT )

Question 3

A- Name 3 drugs that causes hirsutism?

Answer 3

Minoxidil
Phenytoin
Cyclosporin

Question 4

N. Name the hormones that are involved in adrenal gland excess and the disease associated?

Answer 4

Cortisol = Cushing / adrenaline = pheochromocytoma / aldosterone = 1ry aldosteronism

Question 5

N. What’s the treatment for Cushing syndrome?

Answer 5

Surgery to the area secreting cortisol ( adrenal , pituitary, ectopic) / besphosphonates for osteoporosis caused by Cushing

Question 6

N . What’s the definitive treatment for pheochromocytoma?

Answer 6

To lower BP: Give alpha blockers ( phenoxypenzamine ) for 7-10 days before surgery ➡️ give Beta blockers ( propranolol ) ➡️ surgery

Question 7

N. Pheochromocytoma are associated with MEN …. & ….., also with neurofibromatosis type …., and VHL syndrome.

Answer 7

MEN type 2 a, 2b and neurofibromatosis type 1 and von-hipple lindau syndrome

Question 8

N. Name the steps of diagnosing pheochromocytoma?

Answer 8

Do plasma free metanephrine or 24h urinary chatecholamines & metanephrines ➡️ CT or MRI ( abdomen/ pelvis ) if imaging is negative do ➡️ 123 MIBG scanning

Question 9

N. What’s the treatment for pheochromocytoma?

Answer 9

Surgery ➡️ annual follow up ( check metanephrines) for long time because of chance of recurrence ➡️ in case if recurrent disease do ➡️ surgery, iodine 131 MIBG therapy, chemotherapy, radiotherapy

Question 10

N. Hypertension resistance despite taking 3 medications + low potassium & metabolic alkalosis is presentation of what?

Answer 10

Hyperaldosteronism

Question 11

N. What’s the treatment for hyperaldosteronism?

Answer 11

Mineralocorticoid receptor antagonists ( spirinolactone), Amiloride ( potassium sparing diuretic ), Eplerenone, or surgery

Question 12

N. Primary hyperaldosteronism is usually 60% because of bilateral adrenal hyperplasia , true or false?

Answer 12

True

Question 13

N. Postoperative ptn presents with hypotension + tachycardia + constitutional symptoms + hyponatremia + hyperkalemia + low cortisol . What’s the most likely diagnosis?

Answer 13

Adrenal insufficiency

Question 14

N. What’s the clinical picture of Addison disease?

Answer 14

Hyperpigmentation + S&S of adrenal insufficiency ( ⬇️ cortisol, BP, sodium ), ⬆️ potassium, heart rate

Question 15

N. Name the risk factor for adrenal hemorrhage?

Answer 15

Anticoagulant therapy ( 🩸 can occur even within therapeutic range ) , postoperative, abnormalities of hemostasis, sepsis

Question 16

N. What’s the treatment for adrenal insufficiency ?

Answer 16

Stress dose Cortisol ( 50-100mg/IV every 6-8 hours) + supportive treatment ( IV fluids & vasopressors