Adrenal Physiology and Addisons

Question 1

Mineralcorticoids secretes what?

Answer 1

Aldosterone

Question 2

Glucorticoids secretes what?

Answer 2

Cortisol

Question 3

The medulla secretes what?

Answer 3

Norepinephrine and Epinephrine

Question 4

All steroid hormones are derived from?

Answer 4

Cholesterol

Question 5

Enzymes needed to make aldosterone are found only where?

Answer 5

Zona Glomerulosa

Question 6

What condition counts for 85% of Adrenal Failure?

Answer 6

Autoimmune Addisons

Question 7

There is positive adrenal autoantibodies to what in 70% of Addisons Cases?

Answer 7

21-OHase

Question 8

Which part of the Adrenal Gland is affected in Addisons?

Answer 8

Adrenal Cortex

Question 9

Which three autoimmune diseases are associated with Addisons?

Answer 9

Thyroid Disease
Type 1 Diabetes
Premature Ovarian Failure

Question 10

Which symptoms are associated with Addisons (Primary Adrenal Failure)? (10)

Answer 10

Weakness
Fatigue
Anorexia
Weight Loss
Skin Pigmentation
Hypotension
Unexplained Vomit/Diarrhoea
Salt Craving
Postural

Question 11

What can be possible clues to diagnose adrenal failure/addisons?

Answer 11

Unexplained Hypoglycaemia

Question 12

How to Diagnose Addisons? (4)

Answer 12

Routine Bloods: U+E, Glucose, FBC
Random Cortisol >450nmol (Not Addisons)
<450 Uncertain
Synacthen Test 
Basal ACTH

Question 13

If Serum Cortisol is low in Short Synacthen Test eg below 30 what does this indicate?

Answer 13

Primary Adrenal Insufficiency

Question 14

If Rapid ACTH Stimulation Test is normal what does this exclude?

Answer 14

Primary Adrenocortical Insufficiency

Question 15

If Plasma ACTH is elevated what does this indicate?

Answer 15

Primary Adrenocortical Insufficiency

Question 16

If Plasma ACTH is suppressed what does this indicate?

Answer 16

Secondary Adrenocortical Insufficiency

Question 17

How to treat Addisons Disease?

Answer 17

Glucorticoid Replacement

• Hydrocortisone
• Prednisolone
• Dexamethasone

Mineralcorticoid Replacement

• Fludrocortisone
• Binds to Mineralcorticoid (Aldosterone) Receptors
• Adjust dose according to Plasma Renin Level and U+E

Question 18

Who needs special care on steroids? (3)

Answer 18

Hypoadrenal Patients
Patients on steroids in doses sufficient to suppress pituitary adrenal axis >7.5mg
Patients who have received such treatment during previous 18/12

Question 19

What action to take for those on steroids when ill? (2)

Answer 19

Minor short illness: double glucocorticoid dose

Major Illness: 100mg Hydrocortisone then reduce by 50% per day

Question 20

What does the Cortex in Adrenal Gland do?

Answer 20

Synthesise and Release Steroid Hormones

Question 21

Name the three layers of the Adrenal Gland?

Answer 21

Zona Glomerulosa
Zona Fasiculata
Zona Reticularis

Question 22

What does the Zona Glomerulosa make?

Answer 22

Mineralcorticoids (Aldosterone)

Question 23

What does the Zona Fasiculata make?

Answer 23

Glucorticoids (Cortisol)

Question 24

What does the Zona Reticularis make?

Answer 24

Androgens and Oestrogens

Question 25

Medulla secretes

Answer 25

Adrenaline and Noreadrenaline