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Year 4: Endocrine > Adrenal Insufficiency > Flashcards

Adrenal Insufficiency Flashcards

1
Q

what are the layers of the adrenal gland

A

outer: zona glomerulosa
middle: zona fasciculata
inner: zona reticularis
medulla

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2
Q

what does the zona glomerulosa secrete

A

mineralocorticoids

- aldosterone

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3
Q

what does the zona fasciculata secrete

A

glucocorticoids

- cortisol

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4
Q

what dose the zona reticularis secrete

A

androgens

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5
Q

what does the adrenal medulla secrete

A

adrenaline + noradrenaline

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6
Q

what increases secretion of aldosterone

A

increased potassium

angiotensin 2

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7
Q

effects of aldosterone secretion

A

increased sodium reabsorption + increases potassium excretion
- acts on the distal convoluted tubule + collecting duct

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8
Q

what is primary adrenal insufficiency

A

destruction of adrenal glands

- usually autoimmune: Addisons

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9
Q

what is secondary adrenal insufficiency

A

inadequate ACTH stimulating the adrenal gland due to problem with pituitary gland

  • pituitary surgery
  • infection
  • ischaemia
  • radiotherapy
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10
Q

what is tertiary adrenal insufficiency

A

inadequate CRH release from hypothalamus

- usually patients on long term steroids

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11
Q

symptoms of adrenal insufficiency

A 
fatigue
low libido 
weight loss
nausea + vomiting 
increased skin pigmentation
hypotension
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12
Q

what is Addisons disease

A

autoimmune destruction of adrenal glands

- primary adrenal insufficiency

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13
Q

blood results Addisons

A

LOW SODIUM

HIGH POTASSIUM

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14
Q

why is there increased skin pigmentation in Addisons

A

ACTH stimulates melanocytes to produce melanin

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15
Q

ACTH levels in

  • primary adrenal insufficiency
  • secondary adrenal insufficiency
A

primary - ACTH high (pituitary trying to stimulate adrenals to release cortisol)
secondary - ACTH low as problem with pituitary

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16
Q

diagnostic test for adrenal insufficiency

A

short synacthen test

- synthetic ACTH is given

17
Q

how is a short synacthen test carried out

A

ideally performed in the morning
synacthen (synthetic ACTH) is given
blood cortisol measured at baseline, 30 mins + 60 mins after administration

18
Q

normal response to synacthen test

A

baseline cortisol will double in response to ACTH

19
Q

synacthen test indicating Addisons

A

baseline cortisol does not rise/less than doubles

20
Q

treatment of Addisons

A

hydrocortisone - replaces cortisol

fludrocortisone - replaces aldosterone

21
Q

what happens to doses of replacement steroids if a patient with Addisons is acutely unwell

A

doses are doubled until they have recovered

22
Q

presentation of an addisonian crisis

A

severe hypotension
reduced consciousness
hypoglycaemia
hyponatraemia, hyperkalaemia

23
Q

treatment of addisonian crisis

A

IV fluids
IV Hydrocortisone (100mg stat, then 100mg every 6 hours)
Dextrose if hypoglycaemic
cardiac monitoring + careful correction of electrolytes

24
Q

what other conditions might be associated with Addisons

A

Hashimoto’s thyroiditis
Vitiligo
Type 1 DM

25
Q

what is congenital adrenal hyperplasia

A

genetic condition resulting in partial-complete deficiency of enzyme needed for aldosterone + cortisol production

26
Q

inheritance of congenital adrenal hyperplasia

A

autosomal recessive

27
Q

what is deficiency in congenital adrenal hyperplasia

A

21a hydroxylase

28
Q

biochemical pattern in congenital adrenal hyperplasia

A

low sodium
high potassium
high urea
(Addisonian picture)

29
Q

symptoms of congenital adrenal hyperplasia in

  • girls
  • boys
A

girls - excess androgens

males - undervirilisation

30
Q

treatment of congenital adrenal hyperplasia

A

long term steroid replacement

  • hydrocortisone
  • fludrocortisone
31
Q

what infection can cause adrenal insufficiency in developing countries

A

TB

Year 4: Endocrine (15 decks)

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