Adrenal Gland Problems

Question 1

what is Addison’s disease?

Answer 1

AI destruction of the adrenal cortex

>90% destroyed before symptomatic

Question 2

what is Addison’s disease associated with?

Answer 2

other AI conditions

Question 3

presentation of Addison’s disease

Answer 3

anorexia, weight loss
fatigue
dizziness, low BP
abdominal pain, vomiting, diarrhoea
skin pigmentation (ACTH)- tanned skin without being on holiday

Question 4

diagnosis of Addison’s disease

Answer 4

bloods
short synacthen test
imaging

Question 5

blood results in Addison’s

Answer 5

low Na+, high K+
hypoglycaemia
antibodies
high ACTH
high renin
low aldosterone

Question 6

what is a short synacthen test?

Answer 6

measure cortisol before and after IV/IM ACTH

Question 7

management of Addison’s disease

Answer 7

do not delay for diagnosis
hydrocortisone and fludrocortisone (monitor BP and K+)
educate on sick day rules, never omit, wear identification

Question 8

why can adrenal crisis occur after long-term steroids?

Answer 8

adrenal atrophy

difference is that ACTH and aldosterone are in tact so just give hydrocortisone

Question 9

what is Cushing’s syndrome?

Answer 9

excess cortisol

Question 10

who is Cushing’s syndrome common in?

Answer 10

women 20-40

Question 11

action of cortisol

Answer 11

increases sensitivity to adrenaline allowing the body to cope with stress

Question 12

presentation of Cushing’s syndrome

Answer 12

moon face
proximal weakness
stretch marks
buffalo hump
abdominal fat and striae

Question 13

diagnosis of Cushing’s syndrome

Answer 13

low ACTH, high cortisol (urine, serum, saliva)

dexamethasone suppression test

Question 14

management of Cushing’s syndrome

Answer 14

remove ectopic

bilateral adrenalectomy

Question 15

what is Conn’s syndrome?

Answer 15

excess aldosterone due to adrenal adenoma

Question 16

presentation of Conn’s

Answer 16

significant hypertension
hypokalaemia
alkalosis

Question 17

diagnosis of Conn’s

Answer 17

measure aldosterone and renin ratio
saline suppression test
adrenal CT and adrenal vein sampling

Question 18

management of Conn’s syndrome

Answer 18

laparoscopic adrenalectomy

if bilateral adrenal hyperplasia use MR antagonists e.g. spironolactone/eplerenone

Question 19

what is congenital adrenal hyperplasia (CAH)?

Answer 19

group of conditions caused by enzyme defects in the steroid pathway

Question 20

what is the most common defect in CAH?

Answer 20

17-OH

Question 21

two types of CAH

Answer 21

1. classical

2. non-classical

Question 22

presentation of classical CAH

Answer 22

males= adrenal insufficiency, poor weight gain
females= genital ambiguity

Question 23

presentation of non-classical CAH

Answer 23

hirsute
acne
oligomenorrhoea
precocious puberty
infertility

Question 24

diagnosis of CAH?

Answer 24

genetic mutation analysis

basal or stimulated 17-OH progesterone

Question 25

management of CAH in children

Answer 25

steroids and aldosterone e.g. spironolactone and eplerenone

surgery

Question 26

management of CAH in adults

Answer 26

control androgen excess
restore fertility
steroids

Question 27

spironolactone and eplerenone side effects

Answer 27

nausea
rashes
gynaecomastia

Question 28

what is a phaeochromocytoma?

Answer 28

tumour of the adrenal medulla that produces excess catecholamines

Question 29

presentation of phaeochromocytoma

Answer 29

triad of hypertension, headache and sweating

Question 30

what is a paraganglioma?

Answer 30

extra-adrenal tumour found usually in the sympathetic chain

Question 31

diagnosis of phaeochromocytoma

Answer 31

catecholamine excess= urine or plasma metanephrines

imaging e.g. CT, MRI, MIBG, PET

Question 32

when should phaeochromocytoma be suspected?

Answer 32

FH
resistant hypertension
<50 with hypertension

Question 33

management of phaeochromocytoma

Answer 33

alpha and beta blockers (a before b)
fluid and/or blood replacement
surgery and chemo with MIBG if malignant

Question 34

when can catecholamines be raised?

Answer 34

CHF
stress

episodic secretion

Question 35

alpha blocker used in phaeochromocytoma?

Answer 35

phenoybenzamine