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My2 endocrinology > adrenal physiology and pathology > Flashcards

adrenal physiology and pathology Flashcards

1
Q

where are the adrenal glands

A

on top of kidneys

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2
Q

histologically, what 3 parts make up the adrenal glands

A

capsule, cortex, medulla

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3
Q

what steroids does the cortex synthesise

A

Mineralocorticoids (aldosterone)/ glucocorticoids (cortisol)/ adrenal androgens(DHEA),

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4
Q

what steroids does the medulla synthesise

A

Catecholamines (epinephrine and norepinephrine)

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5
Q

what are steroids in the adrenal cortex made from

A

cholesterol

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6
Q

what causes cortisol (glucocorticoid) to be released from the adrenal cortex and what is the axis

A

stress response: hypothalamus releases CRH –> ant pit releases ACTH –> adrenals releases cortisol

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7
Q

which zona is cortisol released from

A

zona fasciculata

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8
Q

what causes aldosterone (mineralocorticoid) to be released

A

low blood pressure or high potassium (from RASAS system)

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9
Q

which zona is aldosterone released from

A

zona glomerulosa

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10
Q

what effect does aldosterone have on Na/K balance

A

Na reabsorption and K excretion

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11
Q

where are steroid receptors

A

nucleus

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12
Q

what effects do steroids have on the body

A

augment sympathetics, stress response, gluconeogenesis, proteinolysis, suppresses immune system, maintain BP, lower mood and libido

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13
Q

what medical uses are steroids for

A

suppress inflamm and immune system

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14
Q

what is adrenal insufficiency

A

inadequate adrenocortical function

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15
Q

what can cause primary adrenal insufficiency

A

Addison’s, congenital adrenal hyperplasia (CAH), adrenal malignancy

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16
Q

what can cause secondary adrenal insufficiency

A

lack of ACTH, iatrogenic (excess steroids), pit/ hypothalamic disorders

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17
Q

what is addisons disease

A

autoimmune destruction of adrenal cortex resulting in increased ACTH but decreased cortisol

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18
Q

what is addisons associated with

A

T1DM, thyroid disease, pernicious anaemia, TB, haemochromatosis

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19
Q

what are symptoms of Addison’s disease

A

anorexia and weight loss, hypotension, amenorrhoea, fatigue, dizziness and low BP, abdo pain, V+D. skin pigmentation

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20
Q

what blood test results would be seen in Addisons (biochem/ ACTH + cortisol / aldosterone/ antibodies)

A

biochem: increased Na, low K/ ACTH: high, cortisol: low / aldosterone: low / antibodies: 21 OH

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21
Q

what diagnostic test is used for adrenal insufficiency

A

synACTHen test: after injection will be no rise in cortisol if adrenal insufficiency

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22
Q

what is the most common cause of secondary adrenal insufficiency

A

exogenous steroid use - increases ACTH eg prednisolone, ICS, dexamethasone

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23
Q

what symptoms differ in primary and secondary adrenal insufficiency and why

A

no skin pigmentation (no ACTH increase), normal BP (normal aldosterone)

24
Q

how do you treat adrenal insufficiency

A

DO NOT DELAY TREATMENT FOR RESULTS: hydrocortisone (cortisol), flucortisone - primary only (mineralocorticoid)

25
Q

what is Cushing’s syndome

A

excess cortisol from adrenal overactivity

26
Q

what is Cushing’s disease

A

excess cortisol and adrenal overactivity FROM a pit adenoma

27
Q

who normal gets cushing’s syndrome

A

women aged 20-40

28
Q

what are main symptoms of Cushing’s (9)

A

thin limbs fat body, striae, alopecia, myopathy, osteoporosis (fractures), think skin and bruising, oedema, acne

29
Q

what effects do excess cortisol have in Cushings

A

protein loss:( myopathy, osteoporosis, thin skin). altered carb and lipid metabolism, T2DM, obesity, psychosis and depression

30
Q

what effects do excess mineralocorticoids and androgens have in Cushings

A

mineralocorticoids: hypertension and oedema/
androgens: virilism, acne, amenorrhoea

31
Q

what can cause Cushing’s (5)

A

pit adenoma (cushings DISEASE) / benign adrenal adenoma / exogenous meds eg steroids /ectopic ACTH production (thymus, lung, pancreas tumour)

32
Q

what is pseudocushings and what can cause it

A

screening test is positive but definitive negative - severe depression and alcohol can cause

33
Q

what is the screening test for Cushing’s

A

dexamethasone at night check cortisol 9 hours later - normal <50, abnormal 130

34
Q

what is the definite Cushing’s diagnosis test

A

2mg of dexamethasone for 2 days, >50 = cushings

35
Q

what surgical treatments are first line for Cushing’s

A

pituitary: hypophysectomy (transspehnoidal) + radio if needed/ adrenal: adrenalectomy / ectopic: remove souce

36
Q

what drugs can be used in Cushing’s if surgery fails

A

metryapone and ketocanazole

37
Q

how do chronic steroids cause adrenal atrophy

A

chronic suppression of ACTH production –> adrenal atrophy

38
Q

what are the dangers of iatrogenic adrenal suppression

A

unable to initiate stress response, CANNOT STOP SUDDENLY

39
Q

what is primary hyperaldosteronism (PA)

A

autonomous production of aldosterone independent of it’s regulators (angiotensin II and K)

40
Q

what are causes of PA

A

adrenal adenoma eg CONNS SYNDROME, bilateral adrenal hyperplasia (most common), genetics eg KCNJ5 channel (rare)

41
Q

what are symptoms of PA

A

HYPERTENSION, frequent, urination, weakness and fatigue, muscle cramps, hypokalaemia, hypernatremia, alkalosis

42
Q

how do you diagnose PA (3)

A

plasma aldosterone and renin, saline suppression test (2L of saline should reduce aldosterone by 50%), adrenal CT

43
Q

when would you treat PA surgically

A

adrenal adenoma (Conn’s) - unilateral adrenalectomy

44
Q

when would you treat PA medically and with what

A

bilateral adrenal hyperplasia - mineralocorticoid antagonist eg spirnolocatone

45
Q

what is congenital adrenal hyperplasia

A

rare condition that causes enzyme defect in steroid pathway of adrenal glands

46
Q

what deficiency is most common in CAH and what does it result in

A

21a hydroxylase –> increased testosterone

47
Q

what symptoms are seen

with CAH as babies (4)

A

adrenal insufficiency weeks 2/3, poor weight gain, increased K, decreased Na+ FEMALE genitalia ambiguity

48
Q

what symptoms can be seen in later life with CAH

A

acne, hirsutism, infrequent periods

49
Q

how do you treat CAH

A

steroid replacement and surgery

50
Q

what is an adrenal medulla tumour cause and what does it cause excess of

A

Pheochromocytoma - excess epinephrine, norepinephrine

51
Q

what classic triad is seen in Pheochromocytoma

A

hypertension, headache, sweating

52
Q

what other symptoms are seen in Pheochromocytoma

A

hyperglycaemia, palpitations, SOB, constipation, anxiety, weight loss

53
Q

what biochem can be seen in Pheochromocytoma (3)

A

hyperglycaemia, hypokalaemia, lactic acidosis

54
Q

how do you diagnose Pheochromocytoma (its hard to do)

A

urine and plasma catecholamine, MRI, PET

55
Q

what is Pheochromocytoma associated with

A

MEN2, neurofibromatosis, TB

56
Q

how do you treat Pheochromocytoma (4)

A

alpha blockers first then beta blockers eg prazosin, doxazosin, propanolol/ fluids / surgical excisiion. chemo if malignant

My2 endocrinology (19 decks)

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