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Endocrinology > Adrenal Pathology > Flashcards

Adrenal Pathology Flashcards

1
Q

What is Addison’s Disease?

A

Primary adrenal insufficiency

Hyposecretion of cortisol and aldosterone

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2
Q

What is the main cause of Addison’s Disease?

A

Autoimmune destruction

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3
Q

Which associated autoimmune conditions are common in Addison’s disease?

A

Thyroid disease

Type I DM

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4
Q

Which antibody is commonly seen in Addison’s disease?

A

Adrenal autoantibodies to 21 hydroxylase

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5
Q

What is there often an infiltration of in Addison’s disease?

A

Lymphocyte infiltration

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6
Q

What are the other causes of Addison’s disease?

A

Infection
Infarction
Iatrogenic

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7
Q

What are common symptoms of Addison’s Disease?

A 
Weakness
Fatigue 
Anorexia 
Weight loss 
Skin pigmentation 
Hypotension 
Unexplained vomiting or diarrhoea 
Salt craving 
Buccal hyperpigmentation
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8
Q

What are possible clues to Addison’s disease?

A

Hypoglycaemia
Unexplained vomiting Nausea
Skin pigmentation
Hypotension/fainting

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9
Q

How is Addison’s Diagnosed?

A

U&E’s
Glucose
Random cortisol
Synacthen test

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10
Q

What is random cortisol levels for Addison’s and not Addison’s?

A 
>700 = not Addison
<700 = Addison
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11
Q

What is the treatment for Addison disease?

A

Glucocorticoid replacement:
Hydrocortisone
Prednisolone

Mineralocorticoid replacement:
Fludrocortisone

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12
Q

What are the glucocorticoid replacement treatments?

A

Hydrocortisone
Prednisolone
Dexamethasone

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13
Q

What are the mineralocorticoid replacement treatments?

A

Fludrocortisone

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14
Q

What are the 3 self care rules for patients on steroids?

A

Never miss a dose
Double hydrocortisone dose in intercurrent illness
If severe diarrhoea or vomiting call for for help without delay

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15
Q

What is congenital adrenal hyperplasia?

A

An adrenal enzyme defect

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16
Q

What is the most common adrenal enzyme defect?

A

21 hydroxylase

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17
Q

What is synacthen test?

A

Involves stimulating the adrenal glands with synthetic ACTH to see how well they respond

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18
Q

What causes Cushing’s Syndrome?

A

Hypersecretion from the adrenal cortex

Cortisol and aldosterone

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19
Q

What is the most common cause of ACTH dependent Cushing’s disease?

A

Pituitary tumour

20
Q

What is ectopic ACTH secretion?

A

When ACTH is coming from another source

E.g lung carcinoid

21
Q

What is the most common cause of ACTH independent Cushing’s?

A

Adrenal tumour

22
Q

What are the signs and symptoms of Cushing;s disease?

A 
o	Central obesity
o	Hypertension
o	Glucose intolerance
o	Hirsutism
o	Amenorrhoea or impotency
o	Purple striae
o	Plethoric faces
o	Bruise easily
o	Osteoporosis
o	Personality changes
o	Acne
o	Oedema
o	Headache
o	Poor wound healing
23
Q

What are the investigations for Cushing’s Disease?

A

24hr urinary cortisol screening

Dexamethasone suppression test

24
Q

What is Conn’s syndrome?

A

Hypersecretion of aldosterone

25
Q

What causes Conn’s syndrome?

A

Adenoma

Or bilateral hyperplasia

26
Q

What is the pathophysiology of Conn’s syndrome?

A

Increased angiotensin increases aldosterone and decreased renin
This increases blood volume, BP and urine K+

27
Q

What are the investigations for Conn’s syndrome?

A

Plasma aldosterone
Plasma renin activity
>20 = primary aldosteronism

28
Q

What is phaeochromocytoma?

A

Hypersecretion of catecholamines

29
Q

What are the clinical features of phaeochromocytoma?

A

Hypertension

Paroyxsmal attacks

30
Q

What are the causes of phaeochromocytoma?

A

Tumours

Inherited origin

31
Q

What is there deficiency of in Addison’s Disease

A

Cortisol

Aldosterone

32
Q

What is synacthen test?

A

Synthetic ACTH administered
Bloods taken 30 and 60 mins after
If increased ACTH but low cortisol and aldosterone confirm’s Addison’s

33
Q

Which test can be helpful for Addison’s

A

Morning cortisol

34
Q

Why does Addison’s cause tanning

A

As ACTH when produced splits with melanocyte stimulating hormone
If ACTH increased so will melanocyte stimulating hormone
Increasing skin pigmentation

35
Q

What is the commonest cause of Cushing’s?

A

Iatrogenic

Over administered steroid treatment

36
Q

Signs of Cushing’s

A 
DM/hyperglycaemia 
Hypertension 
Moon face
Fatty deposits/buffalo hump 
Skin and muscle atrophy 
Poor healing 
Osteoporosis
37
Q

What is the Overnight dexamethasone test?

A

Give 1mg dexamethasone at midnight
Should have suppressed to <50nmo/L by morning
If not = cushing’s

38
Q

Treatment for Cushing’s disease

A

Pituitary adenoma removal

Transsphenoidal

39
Q

Treatment for Ectopic ACTH secretion

A

Try to localise and remove tumour if it hasn’t spread

40
Q

What is the most common cause of mortality in Cushing’s?

A

Cardiovascular mortality

41
Q

Classic triad of phaechromocytoma

A

Headache
Sweating
Tachycardia

42
Q

Diagnosis for phaechromocytoma

A

24hr urinary
Metanephrines
Metadrenaline

43
Q

What is addisonian crisis?

A

Emergency situation where someone has very low steroid levels

44
Q

What can cause addisonian crisis?

A

Missed medication

Or when dose has not been doubles to deal with stress

45
Q

Signs of adrenal crisis?

A 
Hypoglycaemia 
Nausea
Vomiting 
Hypovolemic shock 
Increase HR
46
Q

Treatment for adrenal crisis?

A

IV fluids
Large canula
Dextrose
IV hydrocortisone

47
Q

Side effects of long term steroid use?

A 
Central adiposity 
Osteoporosis 
Hypertension 
DM (hyperglycaemia)
Cushing’s syndrome

Endocrinology (19 decks)

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