Adrenal Glands and the Pancreas

Question 1

Describe features of primary hyperaldosteronism

Answer 1

Conn’s Syndrome - Renin levels are low, metabolic alkalosis and hypokalaemia. Aldosterone levels remain high and ignore negative feedback loop.
Most common cause is bilateral nodular hyperplasia. Less common is a small solitary aldosterone producing adenoma.

Question 2

Describe features of secondary hyperaldosteronism

Answer 2

Renin is high. Can occur due to reduced renal perfusion

Question 3

What is the mechanism involved in congenital adrenal hyperplasia?

Answer 3

21 hydroxylase deficiency or 11-beta hydroxylase deficiency,

Question 4

Name some tumours of the endocrine pancreas

Answer 4

• Tumours of Islet cells = Pancreatic neuroendocrine tumours.
• Beta cells = insulinoma (recurrent hypos),
• Alpha cells = Glucagonoma (diabetes symptoms + characteristic rash)
• Delta cells = Somatostatinoma,
• Gastrinoma

Question 5

What are the mechanisms of damage in diabetes?

Answer 5

1. Advanced glycation end products- non-enzymatic reaction between glucose and proteins which effects their structure.
2. Sorbitol pathway - Cells of retina, kidney and nerves allow free transport of glucose in and out. Conversion of glucose to sorbitol which exerts osmotic pressure effect

Question 6

What are some of the chronic complications of diabetes mellitus?

Answer 6

• Accelerated atheroma which can cause MI, cerebrovascular disease.
• Retinopathy,
• Nephropathy,
• Neuropathy

Question 7

What causes of Cushing’s disease will you see low ACTH?

Answer 7

• With chronic administration of glucocorticoids.

- Primary adrenal adenomas

Question 7

What causes of Cushing’s disease will you see low ACTH?

Answer 7

• With chronic administration of glucocorticoids.

- Primary adrenal adenomas

Question 8

Describe features of adrenocortical adenomas

Answer 8

• Often clinically silent (non-functioning)
• If functioning then it can cause hyperaldosteronism or cushingoid features.
• Mostly sporadic and low malignant potential so only resect if functional

Question 9

What is phaeochromocytoma?

Answer 9

Tumour of chromaffin cells. Intermittently produces catecholamines.
Symptoms include hypertension, sweating, collapse and glycosuria.
Can be part of MEN

Question 10

What are the causes of adrenal crisis?

Answer 10

• Long term steroids can cause sepsis,
• Rapid weaning/withdrawal of steroids,
• Massive adrenal haemorrhage,
• Infections such as meningococcal septicaemia,
• Disseminated intravascular coagulation.

Question 11

What are the features of primary adrenal insufficiency?

Answer 11

Addison’s Disease. Symptoms can be very non-specific but can present with low mood, unexplained nausea and vomiting, weight loss and constipation.
Most common cause is autoimmune but can be due to infection or metastatic cancers