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Endo finals > Adrenals > Flashcards

Adrenals Flashcards

1
Q

Define Cushing’s syndrome and Cushing’s disease

A

Cushing’s syndrome: signs and symptoms of raised cortisol levels
Cushing’s disease: syndrome caused specifically by an ACTH-producing pituitary tumour

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2
Q

Describe the presentation of Cushing’s syndrome

A
  • Weight gain + centripetal obesity
  • Fatigue
  • Weakness + proximal myopathy
  • Skin: purple striae, thin skin, bruising
  • Fat: moon face, buffalo hump
  • Hirsutism, acne
  • High BP (HTN)
  • Glycosuria (T2DM)
  • Osteoporosis
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3
Q

Describe the aetiology of Cushing’s syndrome

A
  1. Most commonly exogenous steroids
  2. Cushing’s disease- pituitary adenoma
  3. Adrenal adenoma
  4. Ectopic ACTH (eg. small cell lung cancer)
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4
Q

Describe the investigations for Cushing’s syndrome

A
  • History and examination (exclude exogenous)
  • BP
  • Urine dip- MSU / 24 hour urine cortisol
  • Bloods: FBC, U+Es, LFTs, bone profile, testosterone (PCOS differential), 9 am cortisol, HbA1c, glucose, lipids, ACTH
  • Special tests: low dose dex suppression test
  • Imaging: MRI head/ CT CAP
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5
Q

Describe how a LDDST works

A

Patient admitted for 3 nights
Day 1: baseline bloods
Day 2-3: frequent low dose dex + bloods

Administer 48 hour of low dose dex

  • In healthy: cortisol should be suppressed
  • In Cushing’s: cortisol remains high
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6
Q

Describe the management of Cushing’s syndrome

A

Depends on cause
Conservative:
-Stop steroids/switch to steroid sparing agents

Medical:
-Adrenal: metyrapone, ketoconazole

Surgical:
-Pit/adrenal: trans-sphenoidal excision, adrenalectomy

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7
Q

What is Nelson’s syndrome?

A

Rapid enlargement of pituitary following bilateral adrenalectomy -> headache, visual field loss etc

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8
Q

Describe the classic presentation of Addison’s disease (patient, signs + symptoms)

A

Middle-aged, previous autoimmune diseases

  • Nonspecific: fatigue, weight loss, anorexia, nausea, abdo pain, dizziness + fainting, hyperpigmentation
  • Adrenal crisis: shock, confusion, reduced consciousness
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9
Q

Describe the aetiology of adrenal insufficiency

A

Primary:

  • Most common in UK: autoimmune disease
  • Worldwide: TB
  • Iatrogenic (adrenalectomy)
  • Mets
  • Haemorrhage (Waterhouse-Friedrichson)

Secondary:
-Hypopituitarism: tumour, iatrogenic, infiltrative, ischaemia etc

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10
Q

What is Waterhouse-Friedrichson syndrome?

A

A syndrome caused by haemorrhage into the adrenals that occurs in a very small number of patients with meningococcal septicaemia

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11
Q

Describe the investigations for adrenal insufficiency

A
  • After history and examination
  • BP, HR, BM
  • Urine dip
  • Bloods: FBC, CRP, U+Es, LFTs, TFTs, 9 am cortisol, ACTH, HbA1c, antibodies
  • Special tests: short synACTHen test
  • Imaging: CT CAP, CXR (TB)
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12
Q

Describe how the short synACTHen test works

A
  • Baseline bloods
  • Give synACTHen dose (to stimulate adrenals)
  • In healthy people: increase in cortisol
  • In adrenal insufficiency: no increase
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13
Q

Describe the management of adrenal insufficiency

A

Medical (mainstay):

-Adrenal replacement: hydrocortisone + fludrocortisone

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14
Q

What is deficient in adrenal insufficiency?

A

Primary: cortisol and aldosterone
Secondary: cortisol

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15
Q

Describe the presentation of adrenal crisis

A
  • Shock: hypotension, confusion, oliguria
  • Hypoglycaemia: sweating, tremor
  • Drowsiness -> coma
  • Severe hyponatraemia + hyperkalaemia
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16
Q

Describe the management of adrenal crisis

A
  • Admission
  • IV fluids
  • IV hydrocortisone 100mg every 6 hours
  • Septic screen + treatment
17
Q

What are some reasons for adrenal crisis?

A
  • Steroids omitted/dose too low eg. illness
  • Sepsis
  • Severe untreated Addison’s
18
Q

Describe the important information to give to patients taking steroids

A
  • Give steroid card (w instructions) + bracelet
  • Do not skip doses or stop taking without consulting Dr
  • Important to double dose with concurrent illness/injury- contact Dr
  • Take in the morning to mimic normal levels
19
Q

What are the typical electrolyte disturbances in adrenal insufficiency and hyperaldosteronism?

A

Adrenal insufficiency: low Na, high K

Conn’s: high Na, low K

20
Q

Describe the presentation of hyperaldosteronism/ Conn’s

A
  • High BP resistant to treatment

- Low K: fatigue, muscle cramps, weakness

21
Q

Describe the causes of hyperaldosteronism

A
  • Adrenal hyperplasia
  • Adrenal adenoma (Conn’s syndrome)
  • Adrenal carcinoma
22
Q

Describe the investigations for hyperaldosteronism

A
  • After history + examination
  • BP
  • Urine dip
  • ECG (hypokalaemia)
  • Bloods: FBC, U+Es, aldosterone:renin ratio
  • Imaging: CT CAP
23
Q

Describe the management of hyperaldosteronism

A

Conservative:
-Reduce salt intake

Medical:
-Spironolactone, epleronone

Surgical:
-Adrenalectomy

24
Q

Describe the presentation of phaeochromocytoma

A
  • Paroxysms of headache, palpitations, sweating, agitation, feeling of impending doom
  • High BP
25
Q

What is the rule of 10s with phaeo?

A

10% bilateral
10% malignant
10% inherited

26
Q

Describe the investigations for phaeo

A
  • History and examination
  • Urine: 24 hour collection for breakdown (metadrenaline, VMA)
  • ECG ?24 hour tape
  • Bloods: FBC, CRP, U+Es, TFTs, cortisol, metadrenaline
  • Imaging: CT abdo, MIBG scan
27
Q

Describe the management of phaeos

A

Medical + surgical

  • Alpha block
  • Beta block (bc if beta alone -> unopposed alpha activity -> vasoconstriction)
  • Surgery: adrenalectomy

Endo finals (6 decks)

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