Adrenal Gland Disorders

Question 1

List 4 common signs of adrenal insufficiency.

Answer 1

1 - Weight loss.

2 - Hyperpigmentation.

3 - Hypotension.

4 - Hyponatraemia (low Na+).

Question 2

List 4 common symptoms of adrenal insufficiency.

Answer 2

1 - Weakness.

2 - Anorexia.

3 - Gastrointestinal issues.

4 - Loss of libido in women.

Question 3

What is Addison’s disease?

Answer 3

An autoimmune attack of the adrenal cortex, resulting in primary adrenal insufficiency.

Question 4

How is adrenal insufficiency diagnosed?

Answer 4

• Using the short synacthen test:

- Based on the measurement of serum cortisol before and after an injection of synthetic ACTH.

Question 5

How is synthetic ACTH different from naturally occurring ACTH?

Answer 5

It is 24 amino acids long instead of 39.

Question 6

What is a secondary adrenal insufficiency?

Answer 6

A form of adrenal insufficiency caused by a lack of ACTH (damage to the pituitary).

Question 7

What is a tertiary adrenal insufficiency?

Answer 7

A form of adrenal insufficiency caused by a lack of CRH (damage to the hypothalamus).

Question 8

List 2 causes of primary adrenal insufficiency.

Answer 8

1 - Addison’s disease.

2 - Congenital adrenal hyperplasia.

Question 9

Why is aldosterone replacement not needed with a secondary adrenal failure?

Answer 9

Because the renin-angiotensin-aldosterone system is still in tact.

Question 10

What is Cushing’s syndrome?

Answer 10

A constellation of signs and symptoms that reflect prolonged and inappropriately high exposure of tissues to glucocorticoids.

Question 11

List 3 causes of Cushing’s syndrome.

Answer 11

1 - Iatrogenic.

2 - ACTH-dependent (pituitary dependent).

3 - ACTH-independent (adrenocortical tumour).

Question 12

List 5 symptoms of Cushing’s syndrome.

Answer 12

1 - Moon faces.

2 - Thin skin.

3 - Bruising.

4 - Striae.

5 - Muscle atrophy.

Question 13

How is Cushing’s syndrome diagnosed?

Answer 13

• Using the dexamethasone suppression test:
• Dexamethasone is administered to mimic the effects of cortisol by binding to glucocorticoid receptors.
• This should cause ACTH to reduce, which should reduce cortisol if the feedback mechanisms are working (not the case with Cushing’s).

Question 14

How can the cause of Cushing’s syndrome be determined?

Answer 14

• By distinguishing between ACTH-dependent and ACTH-independent.
• If ACTH is high, it is ACTH-dependent and likely due to a tumour.
• If ACTH is low, it is ACTH-independent and likely due to an adrenal tumour.

Question 15

How is Cushing’s syndrome treated?

Answer 15

• Surgery (remove the tumour or remove the adrenal glands).

- Drugs (block steroidogenesis or cortisol-producing enzymes or block glucocorticoid receptors).