Adrenal Gland Conditions, Signs, Causes And Differentials

Question 1

What is primary hyperaldosteronism?

Answer 1

An excess of the adrenal mineralocorticoid hormoene aldosterone.

Question 2

What are the signs of hyperaldosteronism?

Answer 2

Muscle weakness, muscle cramps and palpitations (signs of Hypokalemia)

Polyuria and polydipsia (induced diabetes insipidus: increased salt retention stimulates thirst reflex)

Hypertension (salt and water retention)

Question 3

What are the causes of primary hyperaldosteronism?

Answer 3

1. Conn’s syndrome - a secreting adenoma of an adrenal gland; unilateral
2. Adrenal hyperplasia - bilateral

Question 4

What is Addison’s disease?

Answer 4

Failure of the adrenal glands to produce sufficient steroid hormones (no change to catecholamine production), leading to:

1. Lack of glucocorticoid release (cortisol)
2. Lack of mineralocorticoid release (aldosterone)
3. Lack of sex steroid production (testosterone)

Note: Addison’s disease is not the same as an Addison’s crisis, one is the lack of production, the other is a dangerous deficiency of the hormones.

Question 5

What are the signs of Addison’s disease?

AKA primary adrenal insufficiency

Answer 5

Hyponatremia, hyperkalemia, dehydration and acidosis (lack of aldosterone)

Lethargy and Weight loss (lack of GC)

Postural hypotension (lack of catacholamines)

Hyperpigmented skin in areas of increased friction (present in 95% of patients)

Question 6

What are the most common causes of Addison’s disease?

Answer 6

Autoimmune dysfunction (most common in developed countries)

TB (most common in undeveloped countries)

Question 7

What are the signs of a pheochromocytoma?

Answer 7

Paroxysmal hypertension (when catecholamine concentration peaks so will blood pressure)

Triad:

1. Pounding headache (Alpha 1)
2. Palpitations (Beta 2)
3. Sweating (Alpha 1)

Question 8

What is a pheochromocytoma?

Answer 8

A secretory tumour or the Adrenergic medullary chromaffin cells.

Up to 25% are familial (hereditary).