Adrenal Gland Physiology & Disorders

Question 1

Where are the adrenal glands found?

Answer 1

on top of each kidney

Question 2

which hormone is produced in the zona glomerulosa?

Answer 2

aldosterone

Question 3

which hormone is produced in the zone fasciculata?

Answer 3

cortisol

Question 4

which hormone is produced in the zone reticularis?

Answer 4

testosterone

Question 5

where are the hormones that control cortisol & androgen production produced?

Answer 5

hypothalamus & anterior pituitary

Question 6

what is aldosterone regulated by?

Answer 6

renin-angiotensin system & plasma potassium

Question 7

what is the renin-angiotensin system activated in response to?

Answer 7

decreased blood pressure

Question 8

what are the 3 main principles of clinical use of corticosteroids?

Answer 8

suppress inflammation
suppress immune system
replacement treatment

Question 9

which receptor does aldosterone work on?

Answer 9

mineralocorticoid receptor

Question 10

where are mineralocorticoid receptors found?

Answer 10

kidneys
salivary glands
gut
sweat glands

Question 11

what is adrenal insufficiency?

Answer 11

inadequate adrenocortical function

Question 12

give some examples of primary adrenal insufficiency

Answer 12

addison’s disease
congenital adrenal hyperplasia (CAH)
adrenal TB/malignancy

Question 13

give some examples of secondary insufficiency

Answer 13

lack of ACTH stimulation
iatrogenic
pituitary/hypothalamic disorders

Question 14

what is the commonest cause of primary adrenal insufficiency?

Answer 14

Addison’s disease

Question 15

what is addison’s disease?

Answer 15

autoimmune destruction of adrenal cortex

Question 16

how do you treat adrenal insufficiency?

Answer 16

hydrocortisone as cortisol replacement

fludrocortisone as aldosterone replacement

Question 17

how is secondary adrenal insufficiency due to pituitary/hypothalamic disease treated?

Answer 17

surgery or radiotherapy

Question 18

what is Cushing’s syndrome due to?

Answer 18

excess cortisol secretion

Question 19

what are the clinical features of cortisol excess?

Answer 19

easy bruising
facial plethora
striae
proximal myopathy

Question 20

what are the ACTH dependent causes of Cushing’s syndrome?

Answer 20

pituitary adenoma
ectopic ACTH
ectopic CRH

Question 21

Cushing’s disease

Answer 21

pituitary adenoma

Question 22

what are the ACTH independent causes of Cushing’s syndrome?

Answer 22

adrenal adenoma
adrenal carcinoma
nodular hyperplasia

Question 23

what is iatrogenic Cushing’s syndrome due to?

Answer 23

prolonged high dose steroid therapy causing chronic suppression of pituitary ACTH production & adrenal atrophy

Question 24

what are the implications of adrenal suppression?

Answer 24

unable to respond to stress

need extra doses of steroid when ill/surgical procedure

Question 25

hypertension + hypokalaemia

Answer 25

primary aldosteronism

Question 26

primary aldosteronism

Answer 26

autonomous production of aldosterone independent of its regulators

Question 27

what are the clinical features of primary aldosteronism?

Answer 27

significant hypertension hypokalaemia alkalosis

Question 28

what are the subtypes of primary aldosteronism?

Answer 28

adrenal adenoma bilateral adrenal hyperplasia rare causes

Question 29

what are the rare causes of primary aldosteronism?

Answer 29

genetic mutations | unilateral hyperplasia

Question 30

what are the surgical ways to manage primary aldosteronism?

Answer 30

laparoscopic adrenalectomy

Question 31

when would you use surgery to manage primary aldosteronism?

Answer 31

when it is unilateral

Question 32

when would you use medical ways to manage primary aldosteronism?

Answer 32

in bilateral adrenal hyperplasia

Question 33

what medication can be used in primary aldosteronism?

Answer 33

MR antagonists

Question 34

what kind of feedback mechanisms regulates cortisol/androgen secretion?

Answer 34

pituitary ACTH secretion negative feedback mechanism

Question 35

what does aldosterone regulate?

Answer 35

blood pressure & electrolyte excretion

Question 36

give an example of congenital adrenal hyperplasia

Answer 36

variants of 21alpha deficiency

Question 37

what happens in classical 21alpha hydroxyls deficiency

Answer 37

salt-wasting | simple virilising

Question 38

what happens in non-classical 21alpha hydroxylase deficiency

Answer 38

hyperandrogenaemia

Question 39

what symptoms are present in males with classical 21alpha hydroxylase deficiency

Answer 39

adrenal insufficiency poor weight gain biochemical pattern

Question 40

what symptoms are present in females in classical 21alpha hydroxylase deficiency

Answer 40

genital ambiguity

Question 41

what symptoms are found in non-classical 21alpha hydroxylase deficiency

Answer 41

``` Hirsute Acne Oligomenorrhoea Precocious puberty Infertility or sub-fertility ```

Question 42

give 3 patterns that would make suspect phaeochromocytoma

Answer 42

Labile hypertension Postural hypotension Paroxysmal sweating, headache, pallor,tachycardia

Question 43

what happens in pharochomocytoma

Answer 43

Adrenal medulla – phaeochromocytoma Extra adrenal [sympathetic chain] - paraganglioma hypertension

Question 44

when is phaochormocytoma usually diagnosed?

Answer 44

under the age of 5

Question 45

what is the classical triad of presenting symptoms for phaeochromocytoma

Answer 45

hypertension sweating headache

Question 46

why are phaeochromocytomas known as the 10% tumour

Answer 46

``` 10% malignant 10% extra-adrenal 10% bilateral 10% associated with hyperglycaemia 10% in children 10% familial ```

Question 47

what would be found in the urine/plasma of people with phaeochromocytomas?

Answer 47

catecholamines

Question 48

what drugs are give in phaeochromocytomas?

Answer 48

``` alpha blockers (phenoxybenzamine) beta blockers (atenolol) ```

Question 49

MEN2 is what?

Answer 49

autosomal dominant disease activating mutation in tyrosine kinase receptor

Question 50

what is MEN2 associated with?

Answer 50

medullary thyroid cancer parathyroid hyperplasia bilateral phaeochromocytomas

Question 51

Von hipple Lindau syndrome is what?

Answer 51

autosomal dominant mutation in VHL gene leading to an accumulation of HIF proteins & stimulation of cellular proliferation