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Endocrine > Adrenal Pathology > Flashcards

Adrenal Pathology Flashcards

1
Q

What are the 2 parts of the adrenal glands and what do each produce?

A

Outer cortex and inner medulla
Cortex: cortisol, androgens + aldosterone
Medulla: catecholamines

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2
Q

Where are the adrenal glands found?

A

Bilaterally superior to kidneys

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3
Q

What is the precursor to hormones produced by the adrenal cortex and what class are these?

A

Cholesterol

Steroid hormones

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4
Q

What is the cause of Addisons disease?

A

Autoimmune adrenal insufficiency - lack of Cortisol

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5
Q

Who is the most likely presenting group of Addisons disease?

A

Young women

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6
Q

How does Addisons present?

A

Anorexia and weight loss, fatigue, skin hyperpigmentation (particularly in creases in hands), abdominal pain, vomiting, diarrhoea

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7
Q

What are the biochemical findings in Addisons disease?

A

Low Na, High K, hypoglycaemia

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8
Q

What test is used to diagnose Addisons disease and what are the results?

A

Synacthen:

If cortisol same after ACTH = Addisons

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9
Q

How is Addisons treated?

A

Hydrocortisone + fluids

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10
Q

What is given if patients are aldosterone deficient?

A

Fludrocortisone

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11
Q

What is congenital adrenal hyperplasia and what causes it?

A

Autosomal recessive genetic condition

Enzyme defect in steroid pathway

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12
Q

How does congenital adrenal hyperplasia present in males and females?

A 
Males:
Adrenal insufficiency (2-3 weeks), Poor weight gain, Biochemical pattern of Addisons (low Na, high K, hypoglycaemia)

Females:
Genital ambiguity

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13
Q

How is congenital adrenal hyperplasia treated?

A

Acute: Hydrocortisone + fluids

Glucocorticoid and mineralocortiocoid (which will suppress androgens)

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14
Q

What causes Cushings syndrome?

A

Excess cortisol, mineralocorticoid and androgens

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15
Q

What is Cushings syndrome compared to Cushings disease?

A

Disease: pituitary cause of excess cortisol
Syndrome: any other cause (adrenal adenoma, ectopic ACTH, pseudocushings)

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16
Q

What is the clinical presentation of Cushings syndrome?

A

Thin skin, proximal myopathy, buffalo hump, central obesity (on thin legs), marked striae, often have associated diabetes

17
Q

How is Cushings syndrome screened for a diagnosed?

A

Screening: overnight dexamethasone suppression test (should switch off cortisol production)
Diagnosis: low dose dexamethasone suppression test (if cortisol remains high = Cushings)

18
Q

How is Cushings disease identified from Cushings syndrome?

A

High dose dexamethasone suppression test

19
Q

How is Cushings treated?

A

If pituitary - Surgery
Adrenal - Surgery
Ectopic - remove source

20
Q

What is Conns syndrome?

A

Primary aldosteronism due to adrenal adenoma

21
Q

How does Conns syndrome present?

A

Resistant hypertension (Increased aldosterone = Na retention + K loss = hypertension),
Hypokalaemia,
Hypernatraemia,
Alkalosis

22
Q

How is conns syndrome diagnosed?

A 
Measure aldosterone + renin and express as ratio (ARR)
Saline suppression test (large dose of saline should suppress aldosterone and renin - if not = primary aldosteronism)
Adrenal CT (to confirm adenoma = cause) - must also have biochemical diagnosis as can have many benign nodules in adrenal gland
23
Q

How is Conns syndrome (primary aldosteronism from adrenal adenoma) treated?

A

If young = surgery

If older = spironolactone

24
Q

What is a phaeochromocytoma?

A

Tumour in adrenal medulla or extra adrenal (in sympathetic chain)

25
Q

How does a pheochromocytoma present?

A

Paroxysmal sweating, headaches, pallor, tachycardia, sense of impending doom
Palpitations, hyperglycaemia, postural hypotension

26
Q

What does a pheochromocytoma effect?

A

Catecholamine production (adrenaline and noradrenaline)

27
Q

How is a pheochromocytoma diagnosed?

A

Urinary 24hour catecholamines or plasma metanephrins

MRI (to identify the source)

28
Q

How is a pheochromocytoma treated?

A

Alpha then beta blockade (alpha = phenoxybenzamine, beta = propanolol)
Definitive = surgery

29
Q

How does an Addisonian crisis present?

A

Diarrhoea and vomiting, confusion and slurred speech, altered consciousness, fever

30
Q

How is an Addisonian crisis treated?

A

Immediate IV hydrocortisone and fluids

Endocrine (8 decks)

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