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Endocrinology > Adrenal pathology > Flashcards

Adrenal pathology Flashcards

1
Q

What are the 3 layers of the cortex?

A
  • zona glomerulosa
  • zona fasciculata
  • zona reticularis
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2
Q

What does the medulla release

A
  • catecholamines

- adrenaline and noradrenaline

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3
Q

What does the zona glomerulosa release?

A
  • aldosterone
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4
Q

What does the zona fasciculata release?

A
  • cortisol
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5
Q

What does the zona reticularis release?

A
  • adrenal androgens
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6
Q

What is cortisol and androgens release dependant on?

A
  • control from hypothalamus and pituitary
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7
Q

What controls the aldosterone release?

A
  • RAAS
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8
Q

What type of receptors do corticosteroids act on?

A
  • nuclear receptors
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9
Q

What is the effects of cortisol

A
  • increase cardiac output
  • increases blood pressure
  • immunosuppressant
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10
Q

What are steroids used for in medicine?

A
  • suppress inflammation
  • suppress immune system
  • replacement treatment
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11
Q

Name a mineralocorticoid?

A
  • aldosterone
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12
Q

What is the effect of aldosterone?

A
  • sodium reabsorption
  • k+ excretion
  • blood pressure regulation
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13
Q

Name a cause of primary adrenal insufficiency

A
  • addison’s disease
  • congenital adrenal hyperplasia
  • adrenal TB
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14
Q

Secondary causes of adrenal insufficiency

A
  • lack of ACTH stimulation
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15
Q

symptoms of Addison’s disease?

A
  • Anorexia
  • fatigue
  • weight loss
  • skin pigmentation
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16
Q

What is the effect of ACTH on skin?

A
  • increased ACTH causes darker skin pigmentation
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17
Q

Addison’s disease is autoimmune destruction of what?

A
  • adrenal cortex
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18
Q

Investigations for Addison’s disease?

A
  • low sodium
  • high potassium
  • short synacthen test
  • adrenal autoantibodies
19
Q

What is the short synacthen test?

A
  • synthetic ACTH
  • measure cortisol release
  • in Addison’s less cortisol
20
Q

Treatment of Addison’s

A
  • hydrocortisone
  • fluids
  • fludrocortisone
21
Q

What should a patient with Addison’s carry?

A
  • emergency steroid card

- in Addison’s crisis - IV steroids

22
Q

What is the skin difference in Addison’s vs secondary adrenal insufficiency?

A
  • Addison’s high ACTH = skin pigmentation

- secondary causes low ACTH = no skin pigmentation

23
Q

What is Cushing’s syndrome?

A
  • excess cortisol secretion

- not by pituitary causes

24
Q

What is Addison’s disease?

A
  • too little cortisol
25
Q

What is the appearance of someone with Cushing’s syndrome?

A
  • moon face
  • striae
  • proximal myopathy
26
Q

Diagnosing Cushing syndrome?

A
  • overnight dexamethasone suppression test

- cortisol remains high

27
Q

Complication of long term steroid usage?

A
  • suppresses ACTH production

- when ill requires more steroid

28
Q

Effect of aldosterone?

A
  • increases blood pressure
  • increases sodium retention
  • risk of atheroma
29
Q

Conn’s syndrome?

A
  • excess aldosterone
  • secondary hypertension due to low potassium levels
  • tumour in cortex?
30
Q

Diagnosis of Conn’s syndrome?

A
  • Aldosterone:renin ration raised

- saline suppression test

31
Q

Treatment of Conn’s syndrome?

A
  • surgical - unilateral laparoscopic adrenalectomy

- spironolactone

32
Q

CAH stands for?

A
  • congenital adrenal hyperplasia
33
Q

What deficiency is associated with CAH?

A
  • 21a hydroxylase deficiency
34
Q

What is the hormone levels in CAH?

A
  • Too little corticosteroids

- more sex hormones

35
Q

What genetic influence is CAH?

A
  • Autosomal recessive
36
Q

Symptoms of CAH?

A
  • poor weight gain
  • salt wasting
  • simple virlising
37
Q

Treatment of CAH?

A
  • Glucocorticoid replacement
38
Q

What stimulates adrenaline and noradrenalin?

A
  • dopamine

- tyrosine stimulates dopamine

39
Q

What are symptoms of phaeochromocytoma?

A
  • labile hypertension
  • postural hypotension
  • sweating, headaches, tachycardia
40
Q

What is phaeochromocytoma associated with?

A
  • MEN2
41
Q

Differential diagnosis for phaeochromocytoma?

A
  • angina
  • anxiety
  • arrhythmia
  • menopause
42
Q

What can be used for diagnosis of phaeochromocytoma?

A
  • catecholamines in urine
  • elevated plasma metanephrine
  • MIBG scan
43
Q

Treatment of phaeochromocytoma?

A
  • alpha blockers
  • surgery
  • beta blockers
  • genetic testing
44
Q

Diagnosing CAH?

A
  • 17 OH progesterone increased

- genetic testing

Endocrinology (16 decks)

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