adrenal gland

Question 1

where are the adrenal glands

Answer 1

above each kidney

Question 2

what are the two parts of the adrenal gland

Answer 2

cortex and medulla

Question 3

what does the cortex produce

Answer 3

steroid hormones eg cortisol, aldosterone, androgens

Question 4

what does the medulla produce

Answer 4

catecholamines eg adrenaline and noradrenaline

Question 5

role of aldosterone

Answer 5

regulates salt and water balance

Question 6

what is addisons disease

Answer 6

cortisol and aldosterone deficiency due to destruction of the adrenal cortex

Question 7

causes of addisons disease

Answer 7

autoimmune
TB
HIV
metastases

Question 8

signs and symptoms of addisons disease

Answer 8

fatigue
abdominal pain
tanning
craving of crisps
vitiligo
hypotension
hairloss
vomiting
diarrhoea
F>M

Question 9

investigations of addisons

Answer 9

bloods- hypnatraemia, hyperkalaemia, hypoglycaemia, low cortisol
short synACTHen test
MRI adrenals
serum antibodies
screen for HIV, TB, malignancy

Question 10

what is short synACTHen test

Answer 10

early morning test
give dose of synthetic ACTH IM or IV
measure serum cortisol 30mins later
normal= serum cortisol>500nmol/L
low= adrenal insufficiency - if high baseline serum ACTH then primary, if low ACTH then secondary eg pituitary disease

Question 11

management of addisons

Answer 11

hydrocortisone/ prednisolone/ dexamethasone (glucocorticoid replacement)
fludrocortisone (mineralcorticoid replacement)
never miss a dose
wristband
higher dose when sick
injection if vomiting or diarrhoea
acute- 1–mg IV hydrocortisone then 50-100mg IV every 8hrs then reduce by 50% every day

Question 12

cushings syndrome

Answer 12

excessive levels of cortisol in the body usually caused by adrenal gland tumour

Question 13

phaemochromocytoma

Answer 13

bengin, can be bilateral

excess production of catecholamines eg noradrenaline and adrenaline

hypertension
paroxysmal attacks
sweating
palpitations
tremor
pallor

episodic presentation

24 hr urinary catecholamines

surgery to remove

Question 14

congenital adrenal hyperplasia CAH

Answer 14

adrenal glands inability to produce cortisol and aldosterone. deficit in 21-hydroxylase

severe- ambiguous genitalia in girls
neonatal salt losing crisis

incomplete- pseudoprecocious puberty in boys
hirsutism women

Question 15

conn’s syndrome/ primary hyperaldosteronism

Answer 15

tumour within adrenal gland that produces excess amount of aldosterone

Question 16

investigations for conns

Answer 16

plasma PA/PRA ratio
if <20 then hypertension
if >20 then conns

Question 17

phaemochromocytoma management

Answer 17

alpha adrenergic blockade and beta blockers
surgery

Question 18

primary hyperaldosteronism / conns

Answer 18

high bp, low potassium levels, muscle weakness, headache, polyuria, excessive thirst, numbness and tingling, visual disturbance

can be asymptomatic

Question 19

layers of the cortex

Answer 19

zona glomerulosa
zona fasciculata
zona reticularis

Question 20

what does the zona glomerulosa produce

Answer 20

mineralcorticoids

Question 21

what does the zona fasciculata produce

Answer 21

glucocorticoids

Question 22

what does the zona reticularis produce

Answer 22

sex steroids - oestrogen, androgens