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MB2: Endocrinology > Adrenal gland > Flashcards

Adrenal gland Flashcards

1
Q

what is produced in the zona glomerulosa

A

mineralocorticoids

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2
Q

what is produced in the zona fasiculata

A

glucocorticoids

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3
Q

what is produced in the zona reticularis

A

androgens

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4
Q

what cells are present in the adrenal medulla and what do they secrete

A

chromaffin cells

catecholamines

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5
Q

describe how cholesterol becomes testosterone

A

synthesised to aldosterone, cortisol or DHEA/androstenedione, converted to testosterone
this is done by many individual enzymes

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6
Q

regulation of cortisol and androgen synthesis?

A

hypothalamus recieves stress, time of day, illness to release CRH to ant pituitary
releases ACTH to cause cortisol production in adrenal
-ve feedback of cortisol on hypothalamus and ant pituitary

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7
Q

describe the peak of cortisol

A

diurnal variation

highest at 6-10am and drops over the day before it is near zero at night

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8
Q

describe regulation of aldosterone synthesis?

A

decreased BP leads to renin activation, angiotensinogen to ATI, converted to ATII by ACE, causes direct vasoconstriction and aldosterone to increase Na retention in kidneys to decrease fluid output

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9
Q

6 classes of steroid receptor

A 
glucocorticoid
mineralocorticoid 
vitamin D 
androgen 
oestrogen 
progestin
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10
Q

effects of cortisol

A

increases blood sugar, lipolysis and proteolysis
decreases cytokines, macrophage activity, leucocyte migration
accelerated osteoporosis
decreased libido
euphoria/psychosis
increased BP, CO, renal blood flow and GFR

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11
Q

what target tissues does aldosterone act on

A

kidneys
salivary glands
sweat glands
gut

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12
Q

causes of primary adrenal insufficiency

A 
addisons disease 
congenital adrenal hyperplasia 
TB/malignancy 
bilateral adrenal haemorrhage 
bilateral adrenalectomy 
drug induced by rifampicin, phenobarbital, anticoagulants
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13
Q

causes of secondary adrenal insufficiency

A 
lack of ACTH stimulation 
sheehans syndrome 
iatrogenic 
pituitary/hypothalamic disorders 
pituitary surgery/haemorrhage 
infection, trauma, tumour of pituitary/hypothalamus 
cushings disease/syndrome 
long term glucocorticoid therapy
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14
Q

clinical features of addisons disease

A 
anorexia 
weight loss 
skin pigmentation 
abdominal pain and vomiting 
diarrhoea
fatigue 
lethargy
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15
Q

what is addisons disease

A

autoimmiune destruction of the adrenal cortex

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16
Q

what other AA conditions is addisons disease associated with

A

pernicious anaemia, T1DM, AA thyroid disease

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17
Q

biochemical diagnosis of addisons disease

A 
hyponatraemia and hyperkalaemia 
hypoglycaemia 
SST - normal is >250 and post ACTH >550nmol/L
high ACTH
renin high and aldosterone low
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18
Q

what test is diagnostic to addisons disease

A

21-OH-Ab is indicative if pt is over 6m

if -ve get CT adrenals for infiltrative disease, malignancy, infection, haemorrhage

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19
Q

management of addisons disease

A

hydrocortisone - IV if unwell and then oral in divided doses
flurocortisone as aldosterone replacement and monitor BP and K
steroid card
sick day rules
cannot stop suddenly

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20
Q

management of adrenal crisis

A 
fluids
100mg hydrocortisone 
hydrocortisone infusion or 6hr IM 
cardiac monitor 
treat cause
21
Q

true/false - there is a need to treat aldosterone in secondary adrenal insufficiency

A

false - aldosterone is managed by RAAS

22
Q

ACTH dependent causes cushings syndrome

A

pituitary adenoma
Ectopic ACTH
ectopic CRH

23
Q

ACTH indepedent causes of cushings syndrome

A

Adrenal adenoma/carcinoma

adrenal hyperplasia

24
Q

clinical features cushings syndrome

A 
easy bruising 
thin skin 
striae 
proiximal myopathy 
interscapular fat pad 
euphoria/altered mood/psychosis 
thin arms/legs 
increased abdo fat 
cataracts 
osteoporosis 
menstrual irregularity 
hypertension
oedema 
decreased libido
hirsutism 
acne 
virilism
25
Q

diagnosis of cushings syndrome

A

overnight dexamethasone suppression test
24 hr urinary free cortisol
late night salivary cortisol
low dose dexamethasone suppression test

26
Q

how to localise cause of cushings disease biochemically?

A

identify if ACTH is high/low
if low it is likely adrenal
if high it is likely pituitary/hypothalamic/adrenal

27
Q

clinical features of primary hyperaldosteronism

A

hypokalaemia
significant hypertension
alkalosis due to loss of H in urine

28
Q

causes of primary hyperaldosteronism

A

adrenal adenoma - conns
bilateral adrenal hyperplasia
genetic mutations
unilateral hyperplasia

29
Q

diagnosis of primary hyperaldosteronism

A

measure plasma aldosterone and renin and express as ratio
rasied ratio do a saline suppression test
failure of aldosterone to suppress by >50% with 2L confirms
Adrenal CT/adrenal vein sample

30
Q

surgical management of primary hyperaldosteronism

A

for adenoma
unilateral laparoscopic adrenalectomy
only if confirmed by CT and adrenal vein sample

31
Q

medical management of primary hyperaldosteronidm

A

bilateral adrenal hyperplasia

use spironolactone of eplerenone

32
Q

what is the main enzyme deficiency in congenital adrenal hyperplasia

A

21a-hydroxylase deficiency

33
Q

diagnosis of congenital adrenal hyperplasia

A

basal or stimulated 17-OH progesterone

34
Q

classical presentation of congenital adrenal hyperplasia

A

adrenal insufficiency
biochemical pattern addisons - low Na and high K
poor weight gain

35
Q

non-classical presentation of congenital adrenal hyperplasia

A 
hirsutism 
acne 
oligomenorrhoea 
precocious puberty 
infertility/subinfertility
36
Q

management of congenital adrenal hyperplasia

A

recognition, glucocorticoid replacement and mineralocorticoid replacement in some
surgical correction
in adults, control androgen excess and restore fertility

37
Q

what amino acids are catecholamines derived from?

A

dopamine, derived from tyrosine

38
Q

what syndromes are associated with phaeo

A

neurofibromatosis
MEN2a
von hippel lindau
tuberous sclerosis

39
Q

classic triad of phaeo? other symptoms?

A 
headache, hypertension, sweating 
palpitations 
anxiety and fear
constipation 
flushing 
incidental 
FHx
40
Q

signs of phaeo

A 
hypertension 
postural hypotension 
pallor 
bradycardia/tachycardia 
pyrexia
41
Q

signs of complications in phaeo

A 
left ventricle failure 
myocardial necrosis 
stroke 
shock 
paralytic ileus of bowel
42
Q

biochemical abnormalities in phaeochromocytoma

A 
hyperglycaemia 
high haematocrit 
low potassium 
mild hypercalcaemia 
lactic acidosis
43
Q

10% rules in phaeo?

A 
10% malignant 
10% bilateral
10% extra adrenal 
10% associated with hyperglycaemia 
10% children 
10% familial
44
Q

who to investigate for phaeo

A 
resistant HTN
HTN in the young 
classical symptoms 
FHx
consider in hyperglycaemia and HTN
45
Q

diagnosis of pheochromocytoma

A

2x 24hr catecholamine urinary
MRI/CT abdo/body
MIBG
PET

46
Q

management of pheochromocytoma

A 
full alpha and beta blockade 
fluid/blood replacement 
surgical 
chemo, radiolabelled MIBG
biochemical and radiolabelled follow up
test for associated genetic conditions/screening family members
47
Q

how is cushings diagnosed from obesity

A 
thin skin, bruising
prox myopathy 
osteoporosis 
conjunctival oedema 
frontal balding in women
48
Q

what can lead to false positives in cushings diagnosis

A

alcohol/depression

exogenous steroid

MB2: Endocrinology (13 decks)

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