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Year 3 Endo > Adrenals > Flashcards

Adrenals Flashcards

1
Q

What is Cushing’s syndrome?

A

Pathological manifestation of hypercortisoloism

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2
Q

What causes Cushing’s syndrome?

A

Exogenous steroids
Pituitary adenoma (Cushing’s disease)
Ectopic ACTH (small cell lung cancer 5%)
Adrenal tumour

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3
Q

Symptoms of Cushings?

A 
Facial rounding
Proxmial myopathy
Thinning of skin
Striae
Metabolic complication
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4
Q

What investigations for Cushing’s?

A

Low dose dexamethasone test

Midnight cortisol to exclude

24hr urinary cortisol

Plasma ACTH

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5
Q

What is the low dose dexamethasone test?

A

11pm dose of dexa which is supposed to suppress ACTH and cortisol production

But in Cushing’s syndrome it will still be elevated in the morning

ACTH could be ‘inappropriately normal’ after dexa. This would indicate Cushing’s and likely pituitary cause.

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6
Q

When might high dose dexamethasone be used?

A

To differentiate between pituitary and ectopic high ACTH

High dose dexa can lower ACTH is cause is pituitary

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7
Q

What is Addison’s?

A

Primary adrenal insufficency

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8
Q

What can cause iatrogenic adrenal insufficiency?

A

Sudden cessation of long term steroid therapy

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9
Q

What causes adrenal insufficiency?

A

TB
Auto-immune
Hypopituitiarism - tumour, surgery, radiotherapy, apoplexy, Shehaan’s

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10
Q

What are symptoms of Addison’s?

A 
Bronze pigmentation
Weakness
Hypoglycaemia
GI disturbances
Weight loss
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11
Q

Why is there pigmentation in Addison’s?

A

High ACTH

POMC pre-cursor

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12
Q

What are the investigations for Addisons?

A

Morning serum cortisol (low when expected high)
Plasma ACTH
Serum electrolytes - not needed for diagnosis
Short SynACTHen test

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13
Q

What is the Short ACTHen test?

A

Give Synthetic ACTH
Cortisol will stay low
Should increase

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14
Q

What is the management for Addisons?

A

Life-long glucorticoids and mineralocorticoids

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15
Q

What is the management for an Addisonian crisis?

A

IV/IM 100mg hydrocortisone bolus
Then 200mg 24 hours infusion hydrocortisone until BP is stable

Rapid IV rehydration (1L of 1 hour)

50ml of 50% dextrose for hypoglycaemia

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16
Q

What is the presentation of an addisonian crisis?

A

Acute adrenal insufficency
Precipitated by stress e.g. infection
Steroid withdrawal

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17
Q

What are the symptoms of an addisonian crisis?

A 
Hypotensive shock
Weakness
Dizziness
Low BP
Low glucose
High K+
18
Q

What is Conn’s?

A

Primary hyperaldosteronism

19
Q

What are the causes of Conn;s?

A

Bilateral idiopathic adrenal hyperplasia

Adenoma

in the ZONA GLOMERULOSA

20
Q

What is the presentation for Conn’s?

A

Hypertension in young person
Refractory to treatment
Hypokalaemia

21
Q

What are the symptoms of hypokalaemia?

A

Polyuria
Polydipsia
Muscle weakness
Arrhythmia

22
Q

What investigations for Conn’s?

A

Plasma:Aldosterone renin ratio would be high

Because of high BP, Kidneys will detect and Renin will be low

But Aldosterone is high

23
Q

What is the management for Conn’s?

A

Unilateral laparascopic adrenalectomy

24
Q

What is a phaochromocytoma?

A

Tumor in the adrenal medulla

Catecholamine producing chromaffin cells

Really high adrenaline

25
Q

What are phaeos associated with?

A

MEN type 2

Von Hippel-Lindau disease

26
Q

What are symptoms of phaeos?

A 
Hypertension
Episodic high BP
Headaches
Palpitations
Tachycardia
Pallor - vasoconstriction
Tremor
Sweating
Anxiety
27
Q

Why is phaeo a med. emergency?

A

Severe hypertension (MI or stroke)
Ventricular fibriillation
Death

28
Q

What are the investigations for phaeo?

A

24 hour urine collection for catecholamines

If clin. suspicion is high to serum metenephrines and norepinephrines

29
Q

What is the management for a phaeo?

A 
Alpha blocker
then
Beta blocker
then 
Surgical excision of tumor
30
Q

Why is an alpha blocker used to treat a phaeo?

A

Block pre-synaptic alpha 2 receptors that will reduce BP (involved with noradrenaline prod.)

e.g. phenoxybenzamine

31
Q

Why do you need a beta blocker in a phaeo?

A

Reflex tachycardia caused by sudden BP drop caused by alpha blocker

e.g. atenolol

32
Q

What are some phaeo facts?

A

10% extra-adrenal
10% malignant
10% bilateral
RARE

33
Q

What causes hyperkalaemia?

A

Reduced excretion:

Reduced GFR in CKD
Endocrine (Addison's)
Drugs e.g. ACEi, ARBs
Decreased renin
Type 4 renal tubular acidosis (diabetic nephropathy)
34
Q

What is rhabdomyolysis?

A

Cell death

Potassium leaves cells

35
Q

Why does acidosis cause hyperkalaemia?

A

H+ enters cells

K+ leaves to correct electrochemical balance

36
Q

What are the signs of hyperkalaemia on ECG?

A

Tall tented T-waves

37
Q

What is the treatment for hyperkalaemia?

A

10mls of calcium gluconate over 10 mins (cardio protective)

50mls 50% dextrose + 10 unites of short acting insulin

Salbutamol as adj

38
Q

Why are insulin and salbutamol used in hyperkalaemia?

A

Insulin drives K+ back into cells, dextrose to prevent hypoglycaemia

Salbutamol too

39
Q

What causes hypokalaemia?

A

Increased excretion

  • Diuretics
  • Conn’s
  • Insulin
  • Salbutamol
  • Metabolic alkalosis
40
Q

What is the treatment for hypokalaemia?

A

Give potassium

Monitor levlels

Year 3 Endo (5 decks)

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