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Endocrine > Adrenal Gland Pathology > Flashcards

Adrenal Gland Pathology Flashcards

1
Q

hyperaldosteronism is pathology of the adrenal

A

cortex and is hyper function. autonomous production of aldosterone independent of its regulators

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2
Q

T/F: hyperaldosteronism is the main 2y cause of HT

A

T

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3
Q

types of hyperalodsteronism

A

1y: Conn’s syndrome- adrenal glands produce too much ald

2y- excessive renin stimulated adrenal glands to produce more aldosterone

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4
Q

aetiology of hyperalodsteronism

A

1y: adrenal adenoma, adrenal hyperplasia
2y: renal stenosis, renal artery obstruction, HF

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5
Q

s/s of hyperalodsteronism

A

hypertension, hypokalaemia, alkalosis

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6
Q

Ix for hyperaldosteronism

A

saline suppression test > aldosterone: renin ratio

1y: low renin, high aldosterone
2y: high renin, high aldosterone

imaging to confirm sub-type

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7
Q

mx of hyperaldosteronism

A

surgical- adrenalectomy, medical mx for hyperplasia

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8
Q

Cushing’s syndrome is also a cause of…

A

adrenal cortex hyperfunction

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9
Q

cushion’s syndrome causes…

A

Adrenal adenoma, adrenal carcinoma, pseudocushing’s, (alcohol, depression), iatrogenic (steroid meds resulting in adrenal atrophy)

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10
Q

hyperplasia of adrenal gland aetiology

A

congenital, acquired (pituitary adenoma, ectopic ACTH)

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11
Q

main sign of congenital adrenal hyperplasia

A

inc androgens

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12
Q

s/s for acquired adrenal hyperplasia

A

inc ACTH related syndromes

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13
Q

what are 2 adrenocortical tumours

A

adrenocortical adenoma and carcinoma

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14
Q

T/F: adrenocortical adenoma is functional

A

F: carcinoma is, adenoma usually non-funcitional

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15
Q

adrenocrotical carcinoma histology to differentiate from adenoma…

A

large (>20cm), capsular/ vascular invasion, mets is its defining feature !

hence poor prognosis

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16
Q

where does adrenocortical carcinoma invade

A

local- kidneys

mets- liver, lung, bone

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17
Q

what is adrenal insuficiency

A

inadequate adrenocortical function- not enough aldosterone/ cortisol produced

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18
Q

Addison’s is __ insufficiency

A

1y

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19
Q

2y adrenal insuf. is

A

lack of ACTH production from pituitary

20
Q

3y adrenal insuf. is..

A

not enough CRH from hypothalamus

21
Q

what could cause acute presentation of adrenal insufficiency

A

rapid steroidal withdrawal, septicaemia infection

22
Q

what is acute adrenal insufficiency due to septicaemia called…

A

waterhouse friedrichsen syndrome

23
Q

name some causes for 1y, 2y and 3y adrenal insuf

A

1y: congenital adrenal hyperplasia
2y: iatrogenic, sheehan’s syndrome
3y: exogenous steroids

24
Q

some s/s of adrenal insufficiency

A

fatigue, nausea, abd pain, dec libido, bronze hyperpigmentation

25
Q

ix for adrenal insuf

A

synachthen test: synthetic ACTH given, cortisol production response assessed

adrenal auto-antibodies assessed

26
Q

mx of adrenal insufficiency

A

hydrocortisone for cortisol

fludrocortisone for aldosterone

27
Q

T/F: only give fludrocortisone in 2y adrenal insufficiency

A

F: only give hydrocortisone in 2y

28
Q

addison’s is…

A

1y adrenal insufficiency due to AI attack on adrenal cortex

29
Q

main finding with addison’s?

A

reduced cortisol and aldosterone

30
Q

s/s of addison’s

A

weakness, fatigue, anorexia, nausea, wt loss, tanned

- dec aldosterone: hypotension & related symptoms

31
Q

what are symptoms of an addisonian crisis

A

vomiting, abd pain, shock, reduced consciousness, weakness

give IV hydrocortisone

32
Q

what is congenital adrenal hyperplasia

A

another cause for 1y adrenal insufficiency- characterised by deficiency in 1 of the enzymes needed or cortisol synthesis

33
Q

what is the most common gene mutation in congenital adrenal hyperplasia

A

21a-hydroxylase deficiency

34
Q

what are the 2 types and their presentations

A

classic: diagnosed at birth- adrenal insufficiency, civilisation, salt-wasting

non-classic: adolescence- hirsutism, menstrual disturbance, acne, precocious puberty

35
Q

how to diagnose congenital adrenal hyperplasia

A

genetic testing

36
Q

neuroblastoma is usually diagnosed within __ months of life

A

18

37
Q

what is pheochromocytoma

A

a cancer of the chromaffin cells of the adrenal medulla which secrete catecholamines (adrenaline)

38
Q

what is phaeochroocytoma commonly referred to as?

A

10% tumour

  • 10% bilateral
  • 10% don’t present with HT
  • 10% familial
  • 10% extra adrenal
  • 10% malignant
39
Q

what is paheochromocytoma that is extra-adrenal called

A

paraganglioma

40
Q

if phaeo is familial, what is it most correlated to?

A

MEN association

41
Q

s/s of phaeo

A

triad of HT, headache, sweating

feeling of impending doom

42
Q

ix for phaeo

A

urine: 2x24hr catecholamines and plasma free metanephrines

43
Q

what are metanephrines

A

break down product of adrenaline

44
Q

mx for phaeo

A

adrenelectomy, full a & b blockade

rx: a blockade (phenoxybenzamine) then b blockade (propranolol)

45
Q

what are the 3 endocrine causes of HT

A

Conn’s (1y hyperaldosteronism), Cushing’s, Phaeo

Endocrine (14 decks)

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