Adrenal gland physiology and disorders Flashcards
What are the secretions of the adrenal glands?
Aldosterone
Cortisol
Androgens (DHEAA)
Catecholamines
What is the main cause of primary adrenal insufficiency?
Addisons disease
What causes Addisons disease?
Autoimmune destruction of the adrenal cortex
What are the main features of Addisons?
Non-specific symptoms such as anorexia, fatigue, malaise, lethargy
Dizziness and low BP
Abdominal pain, nausea and vomiting
Skin pigmentation
What is the main diagnostic test in Addisons?
Short synacthen test
How is Addison’s treated?
Replacement of hydrocortisone and fludrocortisone
Why is it not necessary to treat with fludrocortisone in secondary adrenal insufficiency due to pituitary disease?
Because RAAS is still intact
Name three situations where primary aldosteronism may be considered as a diagnosis.
Resistant hypertension in the young
Hypokalaemia
Alkalosis
How does primary aldosteronism present?
Often asymptomatic
Signs of hypokalaemia
Polyuria, polydipsia
What are the two main causes of primary aldosteronism?
Conn’s syndrome (adrenal adenoma)
Bilateral adrenal hyperplasia
Which suppression test is used to confirm primary aldosteronism?
Saline suppression test (saline should suppress aldosterone)
How is a) Conn’s b) bilateral adrenal hyperplasia managed?
a) Adrenalectomy
b) Spironolactone (mineralocorticoid receptor antagonist)
What causes congenital adrenal hyperplasia?
Inherited autosomal recessive mutations in corticosteroid synthesis. Usually 21-hydroxylase
How does C.A.H. typically present in a) infants b) young boys c) young girls d) late onset (atypical)?
a) salt-losing crisis b) precocious puberty c) ambiguous genitalia d) signs of androgen excess e.g. hirsutism, oligomenorrhoea, subfertility
How is C.A.H. diagnosed?
Basal 17-OH progesterone
Synacthen test- inappropriate rise in progesterone
