Adrenal Gland Pathology Flashcards
hyperaldosteronism is pathology of the adrenal
cortex and is hyper function. autonomous production of aldosterone independent of its regulators
T/F: hyperaldosteronism is the main 2y cause of HT
T
types of hyperalodsteronism
1y: Conn’s syndrome- adrenal glands produce too much ald
2y- excessive renin stimulated adrenal glands to produce more aldosterone
aetiology of hyperalodsteronism
1y: adrenal adenoma, adrenal hyperplasia
2y: renal stenosis, renal artery obstruction, HF
s/s of hyperalodsteronism
hypertension, hypokalaemia, alkalosis
Ix for hyperaldosteronism
saline suppression test > aldosterone: renin ratio
1y: low renin, high aldosterone
2y: high renin, high aldosterone
imaging to confirm sub-type
mx of hyperaldosteronism
surgical- adrenalectomy, medical mx for hyperplasia
Cushing’s syndrome is also a cause of…
adrenal cortex hyperfunction
cushion’s syndrome causes…
Adrenal adenoma, adrenal carcinoma, pseudocushing’s, (alcohol, depression), iatrogenic (steroid meds resulting in adrenal atrophy)
hyperplasia of adrenal gland aetiology
congenital, acquired (pituitary adenoma, ectopic ACTH)
main sign of congenital adrenal hyperplasia
inc androgens
s/s for acquired adrenal hyperplasia
inc ACTH related syndromes
what are 2 adrenocortical tumours
adrenocortical adenoma and carcinoma
T/F: adrenocortical adenoma is functional
F: carcinoma is, adenoma usually non-funcitional
adrenocrotical carcinoma histology to differentiate from adenoma…
large (>20cm), capsular/ vascular invasion, mets is its defining feature !
hence poor prognosis
where does adrenocortical carcinoma invade
local- kidneys
mets- liver, lung, bone
what is adrenal insuficiency
inadequate adrenocortical function- not enough aldosterone/ cortisol produced
Addison’s is __ insufficiency
1y
2y adrenal insuf. is
lack of ACTH production from pituitary
3y adrenal insuf. is..
not enough CRH from hypothalamus
what could cause acute presentation of adrenal insufficiency
rapid steroidal withdrawal, septicaemia infection
what is acute adrenal insufficiency due to septicaemia called…
waterhouse friedrichsen syndrome
name some causes for 1y, 2y and 3y adrenal insuf
1y: congenital adrenal hyperplasia
2y: iatrogenic, sheehan’s syndrome
3y: exogenous steroids
some s/s of adrenal insufficiency
fatigue, nausea, abd pain, dec libido, bronze hyperpigmentation
ix for adrenal insuf
synachthen test: synthetic ACTH given, cortisol production response assessed
adrenal auto-antibodies assessed
mx of adrenal insufficiency
hydrocortisone for cortisol
fludrocortisone for aldosterone
T/F: only give fludrocortisone in 2y adrenal insufficiency
F: only give hydrocortisone in 2y
addison’s is…
1y adrenal insufficiency due to AI attack on adrenal cortex
main finding with addison’s?
reduced cortisol and aldosterone
s/s of addison’s
weakness, fatigue, anorexia, nausea, wt loss, tanned
- dec aldosterone: hypotension & related symptoms
what are symptoms of an addisonian crisis
vomiting, abd pain, shock, reduced consciousness, weakness
give IV hydrocortisone
what is congenital adrenal hyperplasia
another cause for 1y adrenal insufficiency- characterised by deficiency in 1 of the enzymes needed or cortisol synthesis
what is the most common gene mutation in congenital adrenal hyperplasia
21a-hydroxylase deficiency
what are the 2 types and their presentations
classic: diagnosed at birth- adrenal insufficiency, civilisation, salt-wasting
non-classic: adolescence- hirsutism, menstrual disturbance, acne, precocious puberty
how to diagnose congenital adrenal hyperplasia
genetic testing
neuroblastoma is usually diagnosed within __ months of life
18
what is pheochromocytoma
a cancer of the chromaffin cells of the adrenal medulla which secrete catecholamines (adrenaline)
what is phaeochroocytoma commonly referred to as?
10% tumour
- 10% bilateral
- 10% don’t present with HT
- 10% familial
- 10% extra adrenal
- 10% malignant
what is paheochromocytoma that is extra-adrenal called
paraganglioma
if phaeo is familial, what is it most correlated to?
MEN association
s/s of phaeo
triad of HT, headache, sweating
feeling of impending doom
ix for phaeo
urine: 2x24hr catecholamines and plasma free metanephrines
what are metanephrines
break down product of adrenaline
mx for phaeo
adrenelectomy, full a & b blockade
rx: a blockade (phenoxybenzamine) then b blockade (propranolol)
what are the 3 endocrine causes of HT
Conn’s (1y hyperaldosteronism), Cushing’s, Phaeo
