adrenal hormone diseases

Question 1

what is conn’s syndrome

- effect on electrolytes

Answer 1

hyperaldosteronism

- hypernatraemia

Question 2

what is addison’s disease

- effect on electrolytes

Answer 2

cortisol deficiency

- hyponatraemia, hyperkalaemia

Question 3

what is the ACTH stimulation test, and how to interpret it

- what disease do you use it to diagnose

Answer 3

ACTH stimulation test, short synacthen test - adrenocorticotropic hormone is injected. then you measure the cortisol and aldosterone level

• if it responds, it means your pituitary isn’t doing job
• if it doesn’t respond, your adrenal is not doing its job
• use it if you think its low (Addison’s disease)

Question 4

dexamethasone suppression test

• what is it
• how to interpret it
• what disease do you use it to diagnose

Answer 4

• add Dex to someone with too much cortisol
• if cortisol drops, you’re normal
• if it stays the same, you have extra cortisol production
• use it to dx. Cushing syndrome

Question 5

acromegaly

• blood test if you suspect it, interpretation
• blood test to confirm dx.

Answer 5

if you suspect it - insulin-like growth factor 1, raised in acromegaly
confirm with GH suppression test using glucose

Question 6

Cushings syndrome - key features (8)

Answer 6

STRESSED
Skin fragile
Truncal obesity
Round faces, reproductive issues
Ecchymosis, elevated BP
Striae
Sugar is high
Excess body hair, electrolyte disturbance (hypokalaemia)
Depression, dorsocervical fat pad (buffalo hump)

Question 7

Addison’s disease - key features (7)

low “STEROID” hormones

Answer 7

Sodium, sugar, steroids (cortisol + aldosterone) are low
Tired and muscle weakness
Electrolyte disturbance (hyperkalaemia, hyponatraemia, hypercalcaemia)
Reproductive changes (loss of pubes, armpit and and body hair), really hot (hyperthermia)
Orthostatic hypotension
Increased skin pigment
Diarrhoea + nausea, depression

Question 8

Addison’s/adrenal crisis key features (5)

‘The 5 x S’s’

Answer 8

Sudden pain abdo/back/legs
Syncope
Shock (hypoglycaemic)
Super low blood pressure, SBP<90mmHg, HR++
Severe vomiting and diarrhoea, makes sodium low (hyponatraemia)

Question 9

Addison’s disease - Mx (8)

• hormone replacement (2)
• lifestyle (3)
• monitoring (3)

Answer 9

cortisol - prednisone 
aldosterone - fludrocortisone
high protein diet
high salt diet
avoid illness/strenuous exercise/stress
monitor and replace steroids prn
monitor for other autoimmune disease
monitor calcium, vit d and OP screening

Question 10

Addison’s/adrenal crisis Mx

Answer 10

DRABCDE
Call for help
urgent ambulance t/f to nearest ED
IV access x 2 large bore
IV n/saline 1l stat
IV hydrocortisone 100mg or dexamethasone 4mg stat
Monitor BSL +/- IV glucose 10%
Monitor UEC