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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
what is Cushing's syndome
excess cortisol from adrenal overactivity
26
what is Cushing's disease
excess cortisol and adrenal overactivity FROM a pit adenoma
27
who normal gets cushing's syndrome
women aged 20-40
28
what are main symptoms of Cushing's (9)
thin limbs fat body, striae, alopecia, myopathy, osteoporosis (fractures), think skin and bruising, oedema, acne
29
what effects do excess cortisol have in Cushings
protein loss:( myopathy, osteoporosis, thin skin). altered carb and lipid metabolism, T2DM, obesity, psychosis and depression
30
what effects do excess mineralocorticoids and androgens have in Cushings
mineralocorticoids: hypertension and oedema/ androgens: virilism, acne, amenorrhoea
31
what can cause Cushing's (5)
pit adenoma (cushings DISEASE) / benign adrenal adenoma / exogenous meds eg steroids /ectopic ACTH production (thymus, lung, pancreas tumour)
32
what is pseudocushings and what can cause it
screening test is positive but definitive negative - severe depression and alcohol can cause
33
what is the screening test for Cushing's
dexamethasone at night check cortisol 9 hours later - normal <50, abnormal 130
34
what is the definite Cushing's diagnosis test
2mg of dexamethasone for 2 days, >50 = cushings
35
what surgical treatments are first line for Cushing's
pituitary: hypophysectomy (transspehnoidal) + radio if needed/ adrenal: adrenalectomy / ectopic: remove souce
36
what drugs can be used in Cushing's if surgery fails
metryapone and ketocanazole
37
how do chronic steroids cause adrenal atrophy
chronic suppression of ACTH production --> adrenal atrophy
38
what are the dangers of iatrogenic adrenal suppression
unable to initiate stress response, CANNOT STOP SUDDENLY
39
what is primary hyperaldosteronism (PA)
autonomous production of aldosterone independent of it's regulators (angiotensin II and K)
40
what are causes of PA
adrenal adenoma eg CONNS SYNDROME, bilateral adrenal hyperplasia (most common), genetics eg KCNJ5 channel (rare)
41
what are symptoms of PA
HYPERTENSION, frequent, urination, weakness and fatigue, muscle cramps, hypokalaemia, hypernatremia, alkalosis
42
how do you diagnose PA (3)
plasma aldosterone and renin, saline suppression test (2L of saline should reduce aldosterone by 50%), adrenal CT
43
when would you treat PA surgically
adrenal adenoma (Conn's) - unilateral adrenalectomy
44
when would you treat PA medically and with what
bilateral adrenal hyperplasia - mineralocorticoid antagonist eg spirnolocatone
45
what is congenital adrenal hyperplasia
rare condition that causes enzyme defect in steroid pathway of adrenal glands
46
what deficiency is most common in CAH and what does it result in
21a hydroxylase --> increased testosterone
47
what symptoms are seen | with CAH as babies (4)
adrenal insufficiency weeks 2/3, poor weight gain, increased K, decreased Na+ FEMALE genitalia ambiguity
48
what symptoms can be seen in later life with CAH
acne, hirsutism, infrequent periods
49
how do you treat CAH
steroid replacement and surgery
50
what is an adrenal medulla tumour cause and what does it cause excess of
Pheochromocytoma - excess epinephrine, norepinephrine
51
what classic triad is seen in Pheochromocytoma
hypertension, headache, sweating
52
what other symptoms are seen in Pheochromocytoma
hyperglycaemia, palpitations, SOB, constipation, anxiety, weight loss
53
what biochem can be seen in Pheochromocytoma (3)
hyperglycaemia, hypokalaemia, lactic acidosis
54
how do you diagnose Pheochromocytoma (its hard to do)
urine and plasma catecholamine, MRI, PET
55
what is Pheochromocytoma associated with
MEN2, neurofibromatosis, TB
56
how do you treat Pheochromocytoma (4)
alpha blockers first then beta blockers eg prazosin, doxazosin, propanolol/ fluids / surgical excisiion. chemo if malignant

My2 endocrinology (19 decks)

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