Adrenal Gland Problems Flashcards
what is Addison’s disease?
AI destruction of the adrenal cortex
>90% destroyed before symptomatic
what is Addison’s disease associated with?
other AI conditions
presentation of Addison’s disease
anorexia, weight loss fatigue dizziness, low BP abdominal pain, vomiting, diarrhoea skin pigmentation (ACTH)- tanned skin without being on holiday
diagnosis of Addison’s disease
bloods
short synacthen test
imaging
blood results in Addison’s
low Na+, high K+ hypoglycaemia antibodies high ACTH high renin low aldosterone
what is a short synacthen test?
measure cortisol before and after IV/IM ACTH
management of Addison’s disease
do not delay for diagnosis
hydrocortisone and fludrocortisone (monitor BP and K+)
educate on sick day rules, never omit, wear identification
why can adrenal crisis occur after long-term steroids?
adrenal atrophy
difference is that ACTH and aldosterone are in tact so just give hydrocortisone
what is Cushing’s syndrome?
excess cortisol
who is Cushing’s syndrome common in?
women 20-40
action of cortisol
increases sensitivity to adrenaline allowing the body to cope with stress
presentation of Cushing’s syndrome
moon face proximal weakness stretch marks buffalo hump abdominal fat and striae
diagnosis of Cushing’s syndrome
low ACTH, high cortisol (urine, serum, saliva)
dexamethasone suppression test
management of Cushing’s syndrome
remove ectopic
bilateral adrenalectomy
what is Conn’s syndrome?
excess aldosterone due to adrenal adenoma
presentation of Conn’s
significant hypertension
hypokalaemia
alkalosis
diagnosis of Conn’s
measure aldosterone and renin ratio
saline suppression test
adrenal CT and adrenal vein sampling
management of Conn’s syndrome
laparoscopic adrenalectomy
if bilateral adrenal hyperplasia use MR antagonists e.g. spironolactone/eplerenone
what is congenital adrenal hyperplasia (CAH)?
group of conditions caused by enzyme defects in the steroid pathway
what is the most common defect in CAH?
17-OH
two types of CAH
- classical
2. non-classical
presentation of classical CAH
males= adrenal insufficiency, poor weight gain females= genital ambiguity
presentation of non-classical CAH
hirsute acne oligomenorrhoea precocious puberty infertility
diagnosis of CAH?
genetic mutation analysis
basal or stimulated 17-OH progesterone
management of CAH in children
steroids and aldosterone e.g. spironolactone and eplerenone
surgery
management of CAH in adults
control androgen excess
restore fertility
steroids
spironolactone and eplerenone side effects
nausea
rashes
gynaecomastia
what is a phaeochromocytoma?
tumour of the adrenal medulla that produces excess catecholamines
presentation of phaeochromocytoma
triad of hypertension, headache and sweating
what is a paraganglioma?
extra-adrenal tumour found usually in the sympathetic chain
diagnosis of phaeochromocytoma
catecholamine excess= urine or plasma metanephrines
imaging e.g. CT, MRI, MIBG, PET
when should phaeochromocytoma be suspected?
FH
resistant hypertension
<50 with hypertension
management of phaeochromocytoma
alpha and beta blockers (a before b)
fluid and/or blood replacement
surgery and chemo with MIBG if malignant
when can catecholamines be raised?
CHF
stress
episodic secretion
alpha blocker used in phaeochromocytoma?
phenoybenzamine
